In between treating patients with idiopathic pulmonary fibrosis (IPF) and protecting them from the surge of COVID-19 ravaging Michigan, pulmonologist MeiLan K. Han, MD, MS, leads groundbreaking research on oxygen delivery in chronic lung disease.
Dr. Han is chief of the University of Michigan’s Division of Pulmonary and Critical Care in Ann Arbor. A spokeswoman for the American Lung Association, she says the coronavirus pandemic’s impact on those with IPF—especially in her state—has been profound.
“Many of those patients depended on regularly attending things like pulmonary rehabilitation, both to keep themselves active but also as a social outlet. Unfortunately, with the pandemic, a lot of those programs got shut down, some permanently,” she said. “Patients have just been really scared to leave their home. They know they’re the most vulnerable. Certainly, before vaccines became available and we understood how important things like masks were, many of these patients were not leaving their house at all.”
The problem is compounded by social isolation, anxiety, and depression, Dr. Han explained—and with caseloads on the rise due to the highly contagious Omicron variant of COVID-19, she said many people in Michigan are simply tired of hearing about coronavirus, so they tune out the news.
“I have patients with IPF I still have not physically seen since the pandemic started,” she said. “We are in dire straits here. It is worse now than it was with the first surge, when we reallocated medical professionals all to doing COVID care.”
In mid-2020, Michigan became ground zero for the national debate over mask mandates, lockdowns, and later, vaccinations. By the end of 2021, the state had recorded more than 1.5 million infections and just over 27,000 deaths; as 2022 began it was logging record numbers of new cases, largely driven by Omicron.
“We’ve tried to keep everything open this time, but it’s such a huge strain on the system,” Dr. Han said. “To be honest, one of my big concerns is that even for patients with IPF who don’t have COVID, their regular care may be impaired. So they end up in the hospital with pneumonia. We can barely take care of our non‑COVID patients on top of this COVID surge.”
A ‘Passion for Research’ on Chronic Lung Disease
Dr. Han, speaking to Rare Disease Advisor in a recent phone interview, said that IPF, in which the cause of lung scarring is unknown, affects roughly 100,000 individuals in the United States.
“Like many aspiring physicians, I was drawn to critical care because there’s so much interesting physiology that goes on in the ICU. That’s how I ended up where I’m at right now,” she said. “Along the way, I also developed a passion for research and so have been quite involved with several clinical trials for chronic lung diseases, both in chronic obstructive pulmonary disease [COPD], which is quite common, as well as IPF which . . . is much more rare.”
Read more about IPF epidemiology
Dr. Han uses innovative diagnostic imaging technologies to treat patients. One of these technologies is parametric response mapping, which allows doctors to register inspiratory and expiratory chest computed tomography (CT) images of patients, and to identify different types of abnormality.
“While we actually originally validated the technique in COPD, we’ve also been investigating its utility for diseases like idiopathic pulmonary fibrosis,” she said.
A Portable Oxygen Device and a New Book
In addition, Dr. Han is working with a small startup company, Aires Medical, to test a portable home system that combines ventilation, oxygen, and drug delivery in one device. Current equipment is bulky, heavy, and often uncomfortable, while portable devices now on the market supply oxygen for only 1-2 hours, which isn’t sufficient for chronic lung disease patients.
“For the majority of IPF patients, the thing we have to address first is oxygen delivery as the lungs start to fail,” Dr. Han said.
“We can have them breathe through a nasal cannula or a mask as we supply oxygen either through a tank or a concentrator. That’s fine if they’re going to sit at home and not move,“ she explained. “But things like exercise and pulmonary rehabilitation are incredibly important for maintaining activity levels and quality of life. And usually, those kinds of devices don’t deliver the really high levels of oxygen that patients with IPF need.”
Some patients may also need ventilation, which increases oxygen levels and helps expel carbon dioxide.
“We’re working with this company to develop a more portable unit that will provide oxygen and ventilation for patients,” she said. “It’s still in the development phase. We’re working to get a clinical trial off the ground to try to understand how we can best meet the needs of the patients.”
Dr. Han recently published a book, Breathing Lessons: A Doctor’s Guide to Lung Health. She explains her motivation for writing the 191-page volume: “During the pandemic, I was bombarded with questions, and I realized there was a huge need for a simple book that explained to the public how their lungs work, how doctors think about chronic lung conditions, how we diagnose them, what are the latest treatments, and also what patients can do to preserve their own lung health,” she said.
Dr. Han added: “I really do think that knowledge is power. If patients can understand how their lungs work, then they can be active participants in their own health care and better advocates for themselves.”
Three Lakes Foundation to Fund Canadian PF project
In related news, the nonprofit Three Lakes Foundation (TLF) announced it will fund a project by Canada’s University of Calgary in Alberta to “identify inhaled exposures that increase the risk of developing pulmonary fibrosis.“
“We know that certain inhaled exposures, such as smoking or asbestos, can lead to some forms of [interstitial lung diseases (ILDs)],” said TLF’s associate director, Bridget Burke, in a press release. “There are other environmental and occupational exposures that could trigger the development of disease, but we don’t have a clear understanding of what those are yet or a standardized tool to help clinicians screen at-risk patients. This project will help us to learn more about PF and turn those learnings into action within the clinic setting.”
Kerri Johannson, MD, professor of medicine and community health sciences at the university’s Cumming School of Medicine, will lead the project. Dr. Johannson also directs clinical research for the school’s ILD program.
The 18-month project will be executed in 4 stages, culminating in a comprehensive questionnaire that will be tested within small prospective registries to evaluate its performance and the ease of its use compared to other exposure-assessment tools currently in use. “The final questionnaire will be available for public use across the PF community,“ the group said.
“Understanding the exposures associated with PF will help us to discover how the disease evolves and progresses,” Dr. Johannson said. “It may also lead us to develop effective interventions and treatments.”