Sotatercept, sold under the brand name Winrevair, has been shown to increase exercise capacity, reduce symptoms that affect day-to-day activities and lower the risk of clinical worsening from the condition.

The FDA approved sotatercept in March under its expedited approval process after determining sotatercept was a “breakthrough drug” that could be a significantly better treatment for a life-threatening condition such as pulmonary arterial hypertension. The condition’s name is sometimes shortened to PAH.

“There’s no cure for pulmonary arterial hypertension, which is why new and better therapies like sotatercept are so important for PAH patients” said John W. McConnell, M.D., a principal investigator in the clinical trial that led to sotatercept’s approval. Dr. McConnell is a pulmonologist with Norton Pulmonary Specialists and medical director of Norton Healthcare’s pulmonary hypertension program.

As a principal investigator in the recently concluded sotatercept clinical trial, Dr. McConnell has extensive experience treating patients with the drug. He is also the principal investigator in two additional studies of sotatercept in combination with other medicines for pulmonary arterial hypertension.

Pulmonary arterial hypertension is rare condition that gets worse over time and is ultimately life-threatening. The condition can lead to right heart failure and can be deadly after a few years.

Pulmonary hypertension is a broad term for high blood pressure that’s localized in the lungs, unlike more widespread hypertension, which is high blood pressure throughout the body. Pulmonary arterial hypertension is the term used to describe rarer instances when the condition is the result of narrowed or blocked pulmonary arteries.

Pulmonary arterial hypertension results from the excessive growth and dysfunction of cells that line the arteries carrying blood from the heart to the lungs. Smaller arteries in the lungs thicken and narrow, restricting blood flow and contributing to high blood pressure in the lung that can damage the heart and restrict physical activity. A right heart catheterization measures pulmonary artery pressure and is a critical part of an accurate diagnosis.

Sotatercept works by inhibiting the cell overproduction and allowing the pulmonary artery and smaller arteries to revert to a healthier structure. It’s the first drug to do this.

Pulmonary arterial hypertension is most common in women between the ages of 30 and 60, according to the American Lung Association. Because the cause of pulmonary arterial hypertension isn’t known, it is sometimes called idiopathic pulmonary arterial hypertension. The condition may have a genetic component, and some conditions increase risk for the disease. Congenital heart disease is a risk factor for the disease, according to the American Heart Association, along with  connective tissue disease, including scleroderma and lupus.

Sotatercept is delivered by an injection that the patient can administer every three weeks. The medication is expensive. Even with insurance, some pulmonary arterial hypertension patients need help with the copay, according to Dr. McConnell. Nurses at Norton Pulmonary Specialists are available to help patients with the process of signing up for the drug once it’s prescribed and applying to sources of copay assistance, according to Dr. McConnell.

Pulmonary arterial hypertension affects an estimated 40,000 people in the United States. As many as half of them may be eligible for sotatercept. Shortness of breath during exercise is a symptom of pulmonary arterial hypertension, according to the National Heart, Lung, and Blood Institute. Symptoms tend to get worse over time and may include dizziness, swelling of the ankles or legs, chest pain, and a racing pulse.

By making the heart work harder to pump blood through the lungs, pulmonary arterial hypertension puts a significant strain on the heart. Over time, the heart muscle becomes weak from the extra effort, leading to heart failure.

Pulmonary arterial hypertension also affects quality of life. Many people with pulmonary arterial hypertension need a continuous infusion therapy administered by a pump that they must carry with them at all times. Oxygen therapy delivered by a constantly present tank may be required as disease progresses.

Clinical trial findings

The clinical trial compared patients who received the new therapy with those who received a placebo.

Among the findings, treatment with sotatercept:

• Resulted in an improvement in day-to-day function for almost a third of people taking the drug, double the number of those who improved taking the placebo
• Led to bigger improvements in six-minute walking distance
• Made it easier for the heart to pump blood through the blood vessels in the lungs
• Reduced the chances of worsening events or death by 84%

Serious side effects were rare, but sotatercept did increase the chance of serious bleeding. This was more likely in patients who also were receiving prostacyclin infusion, were on blood thinners or had low platelet counts. Sotatercept also may increase hemoglobin, which could lead to erythrocytosis, a thickening of the blood that makes it less able to travel through blood vessels and organs.

The most recently completed clinical trial tested the drug in patients who met the World Health Organization criteria for functional class II or III, meaning they had no symptoms while resting, but had varying severity of symptoms while physically active.

A study currently underway at Norton Pulmonary Specialists is testing the safety and efficacy of the drug in patients who are in class III or IV and at high risk of death.

Sotatercept is given along with conventional background medication for pulmonary arterial hypertension. Lung transplant is also a treatment for advanced stages of the disease.

Current clinical trials for pulmonary arterial hypertension at Norton Pulmonary Specialists

The post Sotatercept: A new pulmonary arterial hypertension treatment appeared first on Norton Healthcare.

Pulmonary hypertension is rare and has no cure. Symptoms can range from mild to severe, but no one knows for sure if or when their pulmonary hypertension will get worse.

Lindsay Thurman has lived on that edge for over a decade.

It all started when she was just 22.

Strange symptoms appear

“I started getting out of breath while doing normal activities,” said Lindsay, now 38 and a high school math teacher. “Just walking up some stairs would get me out of breath. I came close to fainting a few times, too.”

At 23, Lindsay moved from Louisville to Texas and started seeing a new doctor.

“He found a heart murmur, and later diagnosed me with pulmonary hypertension. Then he eventually sent me to a [pulmonary] specialist.”

The specialist did more in-depth testing.

“When I called the office to get my test results — they told me I was fine; they didn’t find anything wrong with me,” said Lindsay, who was surprised and confused. “I was still having some symptoms.”

For the next three years, Lindsay’s symptoms not only came back, but got worse.

“I started to pass out,” she said. “I went back to the specialist who had told me I was fine. I learned there was a mistake at the office, because they were confused as to why I had never come back after my testing.”   

For Lindsay that was frustrating, to say the least.

“Statistics show that people diagnosed with pulmonary hypertension survive for a little less than three years without treatment,” she said.

New doctor, new outlook

In Louisville, Lindsay connected with John W. McConnell, M.D., pulmonologist specializing in pulmonary hypertension with Norton Pulmonary Specialists.

“I had not had a good experience with my specialist in Texas, so I was wary and skeptical,” Lindsay said. “But I started to see Dr. McConnell, and I realized over time that the team there was completely different.”

Besides building trust with his new patient, Dr. McConnell got Lindsay enrolled in clinical drug trials. 

Lindsay is now a firm believer that having a health care team you trust is very important.

“If you can’t trust them, and you don’t feel they listen to you or respect you, it’s hard to know if you’re doing what is best for you,” she said. And what is best for Lindsay is taking care of her health. From yoga to healthy eating, she has learned to listen closely to her body. In good weather, you can find her running marathons or hiking. She also enjoys hanging out with her dogs and nieces.

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A COPD exacerbation is sometimes called a flare-up. When symptoms of COPD become worse quickly, it might be an exacerbation. Exacerbations may be triggered by severe allergies, a common cold or a sinus infection.

“If your symptoms become severe, even for a short time, it’s a good idea to tell your health care provider as soon as possible,” said Josephine Mei, M.D., pulmonologist with Norton Pulmonary Specialists.

6 signs COPD is getting worse

1. Shortness of breath: Of course COPD includes difficulty breathing, but if you are having shortness of breath after climbing stairs or walking up a gentle incline, that is a potential cause for concern.
2. Wheezing: Inflammation causes narrowing of the airway and can cause wheezing. Not everyone with COPD wheezes, but a study suggested that wheezing is typical in more severe COPD symptoms, more frequent exacerbations and decreased lung function. “Wheezing that comes on quickly or stays constant is a sign to seek medical attention,” Dr. Mei said.
3. Changes in mucus: Mucus, also called sputum or phlegm, is the sticky material that lines your nose, lungs and sinuses. When you cough or sneeze, you may spit out some of this mucus. The color of the mucus you produce is important.
   “Typically, we see clear or slightly cloudy sputum, but during an exacerbation, it may turn yellow or even green,” Dr. Mei said. “That could mean an infection in the lungs.”
4. Changes in cough: Coughing is a typical symptom of COPD, but a cough that gets worse or persists for several weeks — or if it is accompanied by chest pain — should be investigated by your health care provider.
5. Fatigue: “Feeling tired or worn out is a common symptom of COPD, because your body has to work harder to get oxygen to the cells,” Dr. Mei said. If you’re feeling extra worn out or fatigued, it is wise to call the doctor. You also may be groggy in the morning as a result of a lack of oxygen or sleep apnea.
6. Swelling: Also known as edema, swelling occurs in the legs, ankles and feet.
   “You can gain anywhere from 5 to 15 pounds from the fluid retained,” Dr. Mei said.
   Other conditions such as pulmonary hypertension and congestive heart failure may contribute to swelling.

How to prevent COPD flare-ups

“Stopping smoking is the most important step if you have COPD,” Dr. Mei said. “That includes staying away from other people who are smoking.” Dr. Mei also advises monitoring weather alerts so you can reduce exposure to the outdoors on poor air quality days.

Some genetic reasons contribute to developing COPD. Be sure to give your health care provider a full health history, in case those genetic conditions can be caught early and possibly slow or stop the onset of COPD.

You also should stay current on your vaccinations such as flu, pneumonia and COVID-19. Talk to your health care provider about medications and exercise programs that can help you stay healthier longer.

The post Is my COPD getting worse? appeared first on Norton Healthcare.

Asthma and COVID-19

Asthma affects the airways of the lungs. At times, these airways can become inflamed or narrowed, which makes breathing difficult. According to the Centers for Disease Control and Prevention (CDC), asthma affects about 1 in 13 Americans. Asthma can be triggered by allergens such as pollen, or by exercise or cold air. Asthma also can be triggered by colds and viruses.

Many think of asthma as a disease that develops in youth, but the truth is that anyone can develop asthma. Adults can develop asthma from infections like bronchitis or pneumonia, or from allergies and irritants like smoke or mold, but the cause is often unclear. Kentucky has the highest percentage of adults with asthma in the country, according to CDC data. Kentucky’s adult death rate from asthma is 10.2 per million, slightly higher than the national norm.

Most current research suggests that having asthma does not mean you will have worse COVID-19 symptoms than someone without asthma. Since the virus attacks the lungs, however, it can potentially lead to breathing issues even after the body clears the virus.

Getting asthma after COVID-19

Research is ongoing about the long-term effects of COVID-19 infection.

“Symptoms of long COVID vary,” said Maroun M. Ghossein, M.D., pulmonologist with Norton Pulmonary Specialists. “Even if you didn’t have symptoms during your infection or your symptoms were mild, the virus still can affect you down the line.”

For patients who have COVID-19, inhaled oxygen tends to have a harder time entering the bloodstream. When the immune system comes in contact with a foreign substance like a virus, it can launch an inflammatory response. This causes airways to narrow, swell and produce excess mucus, and the muscles around them to tighten up. Mucus then builds up, resulting in the onset of associated symptoms — cough, chest pains, wheezing, etc.

“The theory is that after a person recovers from COVID-19, they still can have fragments of the virus in their system, disrupting the body in some way even if these can no longer infect the cells,” Dr. Ghossein said. “Another possibility is that within the first couple of weeks of the infection, the massive inflammation makes the immune system go haywire, and it take quite a long time to recover.”

That long recovery time is why patients may feel symptoms weeks or months after having COVID-19.

If you are experiencing symptoms of long COVID-19, see a health care provider.

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Microscopic air sacs in the lungs — alveoli — are doing much of your respiratory system’s work. In a patient with COVID-19, these air sacs can become inflamed or filled with fluid, leading to shortness of breath and possibly dangerously low oxygen levels.

Help your lungs; get up and move

Anytime you spend extended time in bed, some of the air sacs in your lungs to shut down temporarily. If you have COVID-19, damage from the virus combines with this natural process to limit the amount of air your lungs can take in, perhaps dangerously so.

One way to counteract COVID-19’s attack on your air sacs is to get more of them working, according to William O. Lacy, M.D., pulmonologist with Norton Pulmonary Specialists.

“This virus loves the lungs. It loves to hang out in your lungs, so don’t make things worse by allowing air sacs to collapse by staying in bed,” Dr. Lacy said. “With COVID-19, you don’t want to compromise your lungs any more.”

So, get out of bed even if it hurts to breathe. Stretch, cough, walk around and take deep breaths. Naturally, we all have portions of our lungs not fully used. By putting more of your lungs to work, you’ll begin to offset COVID-19’s effect of shutting down parts of them, according to Dr. Lacy.

If you’ve ever had surgery, your providers have pushed you to blow into a tube to push a ball higher and higher. The device, an incentive spirometer, performs the same task to get your lungs reopened after general anesthesia.

When you are in bed, spend some time on your stomach or side. Lying in a prone position can help air get into more parts of your lungs, because lying on your back puts pressure on parts of your lungs, causing them to collapse.

The post Sick in bed with COVID-19? Here’s why you need to get up appeared first on Norton Healthcare.

“Things were different back then, and it’s just what you did,” she said.

She was what you would call a heavy smoker, smoking at least a pack a day for at least 30 years. She finally quit in 2007.

A retired nurse, Margaret credits a simple screening for detecting her lung cancer before it had gotten past the early stages. She now tells everyone she knows about this important test.

Margaret had three friends diagnosed with stage 4 lung cancer within six months of each other. All had smoked, and none had any symptoms of lung cancer. One had a swollen lymph node in the neck. One was thought to have allergies that caused swelling in the face. The other’s was found by accident. They all died.

Shortly afterward, she saw an ad in the newspaper. The ad, coupled with the friends’ deaths, caused Margaret to ask her primary care provider if he could refer her to Norton Healthcare for a screening.

“I didn’t have any symptoms, but I knew I should check,” she said. “I go to the gym every day. I wasn’t short of breath, and I wasn’t coughing.”

Catching Lung Cancer Early

She had her first screening at Norton Healthcare, which was clear, and continued screenings for the next three years. Then two small nodules appeared. Three months later the nodules had changed, and Margaret had surgery in February 2019 with George J. Mikos, M.D., cardiothoracic surgeon with Norton Cardiothoracic Surgery. The nodules were cancerous.

Nationally, the American Lung Association reports that only 21.5% of lung cancers are caught at an early stage, which is when the cancer is most treatable.

A recent report from the American Cancer Society shows that from 2016 to 2017, cancer deaths declined 2.2%, with lung cancer deaths also declining. Kentucky also is seeing a drop in deaths attributed to lung cancer. Lung cancer screenings can help make these numbers decline even more.

“Because of the screening, my cancer was caught early,” Margaret said. “I didn’t have to have chemo or radiation, but I will keep going back for scans. So far the two I’ve had have been clean.

“The screening saved my life. If you’re a former smoker, you need to know about this.”

About Lung Cancer Screening

A computed tomography (CT) scan of the lung is painless, noninvasive and fast. The scans are available at Norton Cancer Institute’s Comprehensive Lung Center for individuals at high risk for developing lung cancer. You may be a candidate if you are age 55 to 74 and are a current smoker or have a 30-pack-year smoking history. This means you smoked one pack a day for 30 years, or two packs a day for 15 years, etc.

You also may qualify for a screening if you have a family history of lung cancer or have signs or symptoms of lung cancer. Talk to your physician to determine if you should have a screening.

Most insurance companies cover the cost of a lung cancer screening. Medicare Part B also generally covers the screenings for those who meet the criteria above. A physician referral is required.

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“While both are chronic conditions of the lungs, emphysema and COPD refer to different aspects of the diseased state of the lungs,” said David A. Hasselbacher, M.D., FCCP, pulmonary disease physician with Norton Pulmonary Specialists. “They are related but not the same.”

COPD refers to a group of lung diseases, one of which is emphysema.

What Is Emphysema?

Emphysema means “full of air.” Emphysema is the gradual destruction of lung tissue, more specifically the alveoli or air sacs. The alveoli function similar to a balloon. When you inhale, air comes in, and the alveoli expand. When you exhale, the alveoli contract, pushing air out.

With emphysema, the alveoli are damaged over a period of time due to air pollution, tobacco smoke, workplace hazards and other factors that cause the walls to thin and sometimes collapse. With emphysema, when the lungs inhale and exhale air, the alveoli no longer function like a balloon but rather like a flimsy plastic grocery bag. The air that is taken in gets trapped in the lung and is unable to push out, making it harder to exhale and, therefore, harder to breathe.

There are stages of emphysema that are rated based on how much air you can blow out of your lungs in one second, commonly known as an FEV1 rating, and the number of hospitalizations in a year due to flare-ups or exacerbations. The final stage of emphysema is what is classified as COPD.

What Is COPD?

COPD is a common disease condition of the lungs making it difficult to breathe. There are two main types of COPD. Long-term cough with mucus (chronic bronchitis) or damage to the lungs over time (emphysema) both may be diagnosed as COPD.

With COPD, lung airflow is obstructed, making it difficult to breathe. Airflow may be obstructed because of damage to the alveoli as with emphysema, or by inflammation of the bronchial tubes or the clogging of the bronchial tubes with mucus from chronic bronchitis. Sometimes both emphysema and chronic bronchitis are present, compounding the difficulty to breathe.

The post Emphysema vs. COPD: What’s the difference? appeared first on Norton Healthcare.

Oprah, 65, thought she had come down with a cold after an overseas trip, but eventually she was diagnosed with pneumonia. She was the latest of a handful of celebrities who have publicly shared their pneumonia diagnoses.

Pneumonia occurs when bacteria, viruses or fungi infect and inflame the lungs and fill air sacs with fluid.

“Today” co-anchor Savannah Guthrie was absent from the show for about a week in September after contracting pneumonia. Whoopi Goldberg of “The View” revealed in March that she had an infection in both lungs, saying the illness nearly killed her.

Pneumonia can be life-threatening and is most dangerous for young children, seniors and those with weakened immune systems.

Pneumonia Vaccines Available

There are vaccines that protect against some types of bacteria and viruses that cause pneumonia, according to Lori Scales, M.D., internal medicine physician and pediatrician with Norton Community Medical Associates – Mount Washington.

The Centers for Disease Control and Prevention (CDC) recommends two vaccines for adults 65 years or older and those at increased risk for disease. The vaccines — given at least a year apart — protect against different forms of pneumococcal bacteria, which can cause meningitis, bloodstream infections, ear infections and pneumonia.

Adults 19 to 64 years old who have chronic medical conditions — including diabetes, heart disease and lung disease — should receive one pneumococcal vaccine, as well as those with alcoholism or who smoke cigarettes.

There are other immunizations that prevent infections that can cause pneumonia. The CDC has published immunization schedules for children and immunization schedules for adults.

“It’s crucial for everyone to be up to date on their vaccines,” Dr. Scales said. “The pneumococcal vaccine protects against many different strains of pneumococcal disease, including those that cause pneumonia, bacteremia and meningitis. We often refer to these shots as the sepsis shots.”

Because flu is a common cause of viral pneumonia, annual flu shots are a must.

The post Celebrity illnesses are reminder to get flu, pneumonia vaccines appeared first on Norton Healthcare.

The first study linking vaping to cancer found nearly 25% of mice developed lung cancer after 54 weeks of exposure to e-cigarette vapors containing nicotine. More than half the mice developed hyperplasia — a frequent precursor to cancer.

A group of mice exposed to nicotine-free vapors had no cases of lung cancer and one case of hyperplasia.

The New York University study had a small sample size — 40 mice — and the rodents experienced full-body exposure since they can’t inhale vapor as deeply as humans. Also, mice respond differently than humans.

Nonetheless, researchers concluded that more research needs to be conducted before e-cigarette vapor can be called safe.

“Even if there isn’t smoke, there is still risk,” said George J. Mikos, M.D., cardiothoracic surgeon with Norton Cardiothoracic Surgery. “In addition to the recent increase of fatal pulmonary illnesses linked to vaping, we now know cancer is a real possibility.”

Erring on the side of caution may be wise considering how little is known about the long-term effects of vaping, according to Dr. Mikos. After all, e-cigarettes have been sold commercially in the United States for only a little over a decade.

The National Institute on Drug Abuse reports that 66% of teens believe that they’re only vaping flavoring and nothing else. In reality, 99% of e-cigarettes sold in the U.S. contain nicotine. The Food and Drug Administration has warned that young people and pregnant women shouldn’t use any vaping product.

The Centers for Disease Control and Prevention has determined that e-cigarette vapor contains: “ultrafine particles, chemicals leading to lung disease such as diacetyl, volatile organic compounds, cancer-causing chemicals, and heavy metals such as nickel, tin, and lead.”

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Don’t try to do it right away. You need to make a plan and let those closest to you know you have decided to quit.

Accept the challenges that lay ahead of you. Since smoking is an addiction, you will be tackling one of the biggest challenges of your life. According to James T. Jennings, M.D., family medicine physician with Norton Community Medical Associates – Brownsboro, if you resume smoking, you have to forgive yourself and start over. Most smokers will attempt to quit five times before they are successful.

Nicotine replacement therapy is available and, if used as directed, is a safe way to help you quit smoking. Gum and patches are the most readily available, while other medications may require a prescription.

How to Quit Smoking

Use the following steps to create a quit plan that helps identify challenges you will face and ways to overcome them.

Pick a Quit Date

Many smokers choose a date within two weeks to quit. This will give you enough time to prepare. Avoid choosing a day where you know you will be busy, stressed or tempted to smoke.

Write out your quit day somewhere where you will see it every day. This will remind you of your decision to become tobacco-free and give you time to prepare.

Let Loved Ones Know You Are Going to Quit Smoking

Quitting is easier with support from important people in your life. Let them know ahead of your quit date that you are planning to quit. Explain how they can help you quit.

Line up additional sources of help, in addition to the people closest to you.

Remove Reminders of Smoking or Tobacco

Get rid of smoking reminders. Clean your car and home. Even the smell of cigarettes can cause a cigarette craving.

Throw away all your cigarettes, lighters, matches, ashtrays, snuff, etc. Don’t save a pack of cigarettes or can of snuff “just in case.”

Identify Your Reasons to Quit

Everyone has their own reasons for quitting. Maybe they want to be healthier, save some money or keep their family safe. As you prepare to quit, think about your own reasons to quit smoking. Remind yourself of them every day. They can inspire you to stop for good. Keep a list of your reasons for quitting in a place where you can see it every day. Any time you feel the urge to smoke or use tobacco, review your list.

Identify Your Triggers

Certain activities, feelings and people are linked to your tobacco use and can trigger your urge. Try to anticipate these triggers and develop ways to deal with them.

Once you’ve identified your triggers, write down one way you can deal with or avoid each trigger. Keep this list nearby during your quit.

Develop Coping Strategies

Withdrawal from nicotine can be unpleasant, but you can get through it.

Medications and behavior changes can help you manage the symptoms of withdrawal. Many medications to help you quit are available over the counter and from your doctor. Make sure you have them on hand prior to your quit.

Don’t rely solely on medications, and turn to the other strategies in your plan. Withdrawal symptoms, including cravings, will fade with every day that you stay tobacco-free.

Set Up Rewards for Milestones

Quitting happens one minute, one hour, one day at a time. Reward yourself as you reach milestones.

Celebrate being 24 hours tobacco-free, one week tobacco-free, one month tobacco-free, etc. Quitting smoking is hard — be proud of your accomplishments.[templatera id=”562073″][templatera id=”562074″]

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