NEW YORK, New York — Noah Greenspan, DPT, says the pulmonary fibrosis (PF) patients and others who had been coming to his Pulmonary Wellness and Rehabilitation Center until he closed it in March 2020 in the wake of the COVID-19 pandemic were among “the oldest, sickest, most complex patients in the book.”
Since then, the cardiopulmonary and medical physical therapist has repurposed his staff to treat COVID-19 patients — and in particular, COVID long-haulers — through his online “boot camp” for those with severe respiratory illnesses.
Over the course of his career, Dr. Greenspan, who also runs the nonprofit Pulmonary Wellness Foundation, says he’s seen at least 1000 PF patients. Fortunately, very few of them have come down with COVID-19.
“All the things that prevent COVID are the same things that prevent the flu, pneumonia, and the common cold. We’ve been training people for this moment for decades,” he said. “Thankfully the majority of our patients are healthy and vaccinated.”
While pre-existing medical conditions could very well exacerbate the symptoms of COVID, he said, “I’ve known of some people with COPD, pulmonary fibrosis, or pulmonary hypertension that did get COVID and survived, and made it through OK.”
Dr. Greenspan, who has a passion for bonsai trees and colorful tattoos, has been treating idiopathic pulmonary fibrosis (IPF) since 1995. Back then, such patients were rarely referred to rehab.
“In fact, it was just the opposite. They were told they were too sick for rehab, and to go home and die,” he said. “But I had a very wonderful mentor named Horatio Pineda, who was a physiatrist at NYU. And we used to struggle with this because it hurt us physically and emotionally to have to turn the sickest patients away. And ultimately, we said, ‘you know what, if our choices are go home and wait to die or try rehab and go down fighting, we really have nothing to lose by trying it.’”
Dr. Greenspan and his team started using oxygen in much more liberal quantities while pushing their patients to exercise.
“One of the tragedies of pulmonary fibrosis, and particularly IPF, is that when patients go to the internet and read about pulmonary fibrosis, the first thing they read is [an]average lifespan of 3 to 5 years. It’s terrifying to patients and it’s not necessarily true. First and foremost, it’s based on old data. Secondly, it’s based on a time when the diagnostics were not as good.”
That’s why it’s crucial that patients see the right specialist, he said.
“Interstitial lung disease is very complex, it’s got a ton of little nuances to it, and it’s not something that every pulmonologist is capable of handling,” he said. “Whereas every pulmonary doctor should be able to handle asthma or COPD, ILD is very different.”
Among the biggest issues IPF patients deal with is the side effects of common therapies such as pirfenidone (Esbriet®) and nintedanib (Ofev®).
“Usually when we take a medication, we expect to feel better, right? And that’s not necessarily the case,” he said. “These medications are not to make you feel better because they don’t reverse fibrosis. But the idea is that we hope that they will prevent fibrosis from continuing to be laid down, right? So that’s one thing that people have to understand.”
Dr. Greenspan said some of his patients have complained of having diarrhea 20, 30, or even 40 times a day as a consequence of these drugs.
“That’s not consistent with leaving the house and living an active life. And it leads us to the question of do you want to live long, or do you want to live well? We hope at some point there’s going to be something that allows both.”
Asked what practical information Dr. Greenspan might offer healthcare professionals when it comes to IPF, he said the most important thing is to keep an open mind.
“First and foremost, keep an open mind. Don’t jump to conclusions. Don’t allow yourself to be tricked into, or don’t trick yourself into, a knee-jerk reaction. Keep your mind open, even when it’s a condition that is not seen very often. But when it does happen, it’s going to be serious.”
He added: “Cast a wide net, continually evaluate and re-evaluate the differential diagnosis, and don’t get set in your ways and don’t get to the point where you assume you know without doing your due diligence.”