Jonathan Weissler, M.D. Answers Questions On: Pulmonology

We are seeing many lung-related problems increasing, including chronic obstructive pulmonary disease (COPD). The increase in COPD is due to a combination of cigarette smoking and environmental causes related to industrial pollutants.

We are also getting better at recognizing pulmonary diseases such as interstitial lung diseases (ILD), which may be due to people living longer in general. ILDs are diseases primarily of older patients. Another disease we are better at diagnosing is bronchiectasis – particularly in women.

Idiopathic pulmonary fibrosis is scarring of the lungs that usually gives people shortness of breath. It usually presents in the fifth, sixth, or seventh decade of life. There’s a familial form of it, and we have a group at UT Southwestern that is at the vanguard of investigating familial pulmonary fibrosis on a basic scientific level.

Several treatments for idiopathic pulmonary fibrosis are on the cusp of being approved by the FDA. A number of drugs are being studied, and we have been involved with the clinical trials for one drug called Pirfenidone for about a decade.

First we take a detailed occupational and environmental history to identify any triggers because there may be drugs or allergens that precipitate severe asthma.

After that, the cornerstone of therapy is to use anti-inflammatories – inhaled corticosteroids. The trick is to use them in the right dose for people with severe asthma, usually in combination with other medicines such as a long-acting bronchial relaxer.

In some cases, severe asthma needs to be treated with antifungal therapy or with other antibiotics on a prolonged basis.