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DEAR DR. ROACH: My husband was recently diagnosed with mild to moderate pulmonary fibrosis. His mother died from pulmonary fibrosis. From what we have read there is no cure, only palliative care. The thought of doing nothing to try to stop the progression is totally unacceptable when there have been such successes with immunotherapy and stem cells. Would he receive more aggressive treatment going to a pulmonary fibrosis care center that has lung disease programs? – C.D.
ANSWER: There are several diseases that may cause fibrosis of the lung, so having an exact diagnosis made by an expert is critical for getting the right treatment. The most common type of pulmonary fibrosis is called “idiopathic pulmonary fibrosis” (it also has been called “usual interstitial pneumonia” and “cryptogenic fibrosing alveolitis”), and I am going to discuss that diagnosis.
The cause of IPF is unknown (both “idiopathic” and “cryptogenic” mean “of unknown cause”), but cigarette smoking is a risk factor. It is usually diagnosed in people who are their 50s and 60s, although some familial cases may come on earlier. IPF can run in families.
Although it is a rare disease, it seems to be on the rise. The major symptoms are cough and shortness of breath.
There is no cure for IPF, but there are treatments available. Two drugs, pirfenidone and nintedanib, are approved for use in the U.S. and Canada. Both of them slow progression of lung disease, reduce exacerbations and have been proven to reduce mortality from the condition, if only slightly. I am concerned that you and your husband apparently haven’t heard of these drugs.
I strongly advise you get a referral to a center for lung disease in order to get your husband the best care. I found 35 IPF trials recruiting patients in the U.S. and six in Canada. A clinical trial will help scientists understand this condition as well as determine the best current treatment. You also can find out what centers have expertise on this condition by seeing where the trials are conducted at www.clinicaltrials.gov. The most aggressive treatment isn’t always the best, but you and your husband deserve to hear about all the options.
The Pulmonary Fibrosis Foundation can help you find experienced centers for treating this condition. You can find them online at www.pulmonaryfibrosis.org.
DEAR DR. ROACH: My niece recently was diagnosed with breast cancer. Radiation was recommended. Her mother said that first she’d have to boost her immune system. Is it possible to actually do that? – P.P.L.
ANSWER: Radiation is a common treatment after breast cancer surgery. It’s done to reduce the risk of recurrence, depending on the exact type of cancer.
Boosting the immune system is a new adjunct for many types of cancer. There are several ways to do this: One is to genetically modify the patient’s own immune T-cells, but many other techniques are in trials now.
However, if your niece’s mother is talking about supplements, I’d be cautious. Supplements that are promoted to boost the immune system generally are ineffective at doing so. Making sure your niece has proper nutrition, gets good sleep and experiences as little stress as is manageable are ways to prevent stress on the immune system. Everyone could benefit from those deceptively simple steps, but especially a person being treated for cancer.
Dr. Roach regrets he is unable to answer individual letters, but he will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.
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