On yesterday’s episode of Grey’s Anatomy, a young patient who needed a lung transplant was also a lousy candidate for one, since he had too many risks. Instead of foregoing the whole thing, an ex-vivo lung transplant was performed on him instead.

Why does someone need a lung transplant, anyway?

There are some diseases that cause such damage to the lungs that a new lung is necessary. Such diseases include (don’t fret the confusing names – we will cover them at one time or another here on A Disease A Day) chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis, cystic fibrosis, idiopathic pulmonary hypertension and others.

So why not give everyone the lungs they need?

There aren’t that many lungs that can be donated to begin with – only about 15-20% of donor lungs are acceptable for transplantation, since lungs are more susceptible to injuries than other donated organs (such as the heart).

Even when we have found a suitable lung for transplantation, not everyone waiting for a lung will get one. Each person waiting for a lung transplant has a score, based on the lung allocation score. For example, people who have a more immediate need for the lung come before those who can wait. Other factors, such as the illness the patient has, other diseases they have, etc. determine their score.

This means that many patients, like the one on the Grey’s Anatomy episode, are left far behind in the list, with a very low chance of ever getting a lung before dying.

What’s an ex-vivo transplant and how does it help things?

This technique was invented in 2008 by a team of lung transplant surgeons led by Dr. Shaf Keshavjee at Toronto General Hospital.

What it does is perfuse a special solution into an injured lung. It lets doctors “treat” the injured lungs while they are outside the body to make them suitable for transplantation. The technique can double the number of lungs fitting for donation.

How is it done?

After the donor lungs are removed from a deceased donor, they are transferred to a protective, transparent bubble-like chamber (like the one seen on the show). Then a series of steps is taken, in which the lungs are connected to a circuit composed of a pump, ventilator and filters through which oxygen, nutrients and a special solution are injected to the lung.

The bubble-like chamber with the lungs in it. Image courtesy of University Health Network

And on a final note – why is it called an ex-vivo transplantation?

Ex-vivo in Latin means “out of the living”. In this case, the healing process for the lungs occurs outside of a human body, inside this bubble-like chamber.

Here’s a video showing the repaired lung in action -

Related posts:

1. Your Questions Answered – Asbestosis – What Work Exposure Can Do To Your Lungs
2. Wilson Disease – The Return (As Seen on House MD)
3. Superior Canal Dehiscence Syndrome – Hearing Sounds Inside Your Own Body (As Seen on Grey’s Anatomy)

Danger level: Medium

What is it?

Asthma is a disease which affects the airways, causing attacks in which breathing is difficult.

Who gets it?

In the Unites States, about 5-10% of the population (or 22 million people) are affected by asthma (6 million of them are children).

Around the world, asthma is more common in industrialized countries, such as Canada, England, Australia, Germany, and New Zealand. 2-10% (300 million) of people worldwide have asthma.

Until puberty, asthma is more common in boys than girls (twice as much). From then on there is no difference. About 2/3 of all asthma cases are discovered before age 18.

The following are considered risk factors, meaning they increase your risk of having asthma:

1. A family history of asthma – Asthma is partly genetic, meaning that if someone in your family has it, your chances of getting it are higher.

2. Frequent infections in your airways as a child

3. Living in an urban area, especially one that contains a lot of air pollution

What causes it?

Asthma causes an inflammation in our airways – these are the “tubes” that lead from our mouth to our lungs. This causes 3 things:

1. Airway obstruction – Our airways are surrounded by muscle. Normally, this muscle is relaxed, so air can move freely to our lungs and back out. In asthma, these muscles tighten and also produce a liquid called mucus. Those things cause the airways to get obstructed, so air can’t move freely.

2. Inflammation – Besides the attacks which cause momentary blocks in the airways, there is also an ongoing inflammation, which can cause long term damage to the airways if not treated.

3. Airway irritability – The airways in asthma patients are very sensitive to things healthy people usually don’t react to, such as pollen or dust. These things can bring about asthma attacks, which involve obstruction of the airways.

This video gives a graphic illustration of the process:

The following things are known to trigger asthma attacks in people with the disease (they change among different people):

a. Airborne materials, such as pollen, animal dander, mold, cockroaches and dust mites

b. Respiratory infections – Such as the common cold

c. Exercise

d. Cold air

e. Smoke

f. Certain medications – Such as aspirin, beta blockers and others.

g. Strong emotions and stress

How does it feel?

Asthma attacks include the following things:

1. Shortness of breath

2. Coughing

3. Wheezing – This is a whistling sound characteristic of asthma patients. It’s heard when you take the air out.

4. Chest tightness or pain

The severity of the disease is different for different people. In some people attacks may appear only after exercise, while in others they may come a few times a day, making their lives miserable.

This video shows someone with an attack who unfortunately ran out of medications and was waiting for an ambulance. Notice the coughing and the whistling sounds when he takes out air. (And please don’t try this at home…)

How is it discovered?

If someone comes to the doctor when they are having an attack, it can be pretty simple (as you can see in the video above) to know that they have asthma.

Unfortunately, by the time someone arrives at the doctor’s, the attacks are often gone. Besides, other diseases can have similar symptoms. Therefore these tests were invented which can discover asthma:

1. Pulmonary function tests – These are special tests done to test the patient’s breathing pattern when they breath into a machine. The pattern in asthma patients is pretty characteristic.

2. Challenge tests – Certain substances, when inhaled by people with asthma, can trigger an attack. Using these substances (such as one called metacholine) helps in diagnosing asthma.

3. Chest X-ray – Can be used to rule out other conditions (such as pneumonia).

How is it treated?

There are a few things which can be done to treat asthma:

1. Avoiding triggers

2. Medications – There are short-term drugs and long-term drugs. The short-term ones are used to control attacks. The long-term drugs are used to control the inflammation in the airways, which prevents long-term damage to them.

We won’t go into much detail about the types of drugs available, but some examples of long-term drugs include corticosteroids, beta agonists, and others.
Short-term drugs are drugs that are usually inhaled, and that cause dilatation of the constricted airways, thereby making it easier to breath. These drugs are taken through special inhalers, such as the one in the picture:

An asthma inhaler. Photo by net_efekt.

What happens after treatment?

Except in very difficult cases, these drugs help to live a normal life with asthma.

Also, about 50% of children diagnosed with asthma are asthma-free after 10 years (in adults the disease doesn’t tend to go away as much).

The bottom line – How do I avoid it?

You can’t avoid asthma altogether, since, as mentioned above, the disease is probably genetic.

What you can do is decrease your risk of having attacks, by following these rules:

1. Stick to your medications

2. Identify your triggers and avoid them – One way of doing this is to keep a diary in which you write down factors you encountered before attacks (such as cold air, a virus, cigarette smoke, etc.). Then take measures to minimize your exposure to these things.

3. Treat allergies – Asthma attacks can also be triggered by any allergies you may have. You should avoid or minimize contact with the substance you are allergic to.
Also consider allergy shots (consult your doctor about those).

4. Get a flu vaccine – Every year. The flu almost always makes asthma much worse.

On a final note, we try to give you a personal angle about diseases we cover here. This time, you can get it by visiting The Angry Asthma Mama blog and The Asthma Mom.

Related posts:

1. Understanding Heart Attacks – Part 2 – Angina Pectoris
2. Cluster Headaches – Excruciating Attacks of Headaches
3. Understanding Heart Attacks – Part 3 – Myocardial Infarction

Recently we started asking you for your health questions. Today we’re inaugurating this column with the first question. You’re welcome to keep sending your questions through here or through Twitter (@diseaseaday).

L. from Malta asks:

“I was told that I have Asbestos in my lungs. I used to serve in the royal navy. I would like to know if there is any means of getting rid of this asbestos from my lungs?”

L.,

To answer your question, I’ll just present you with the facts about Asbestosis, in the same way we usually do here on A Disease A Day.

Danger level: Medium

What is it?

Asbestosis is a lung disease caused by inhalation of asbestos fibers.

Who gets it?

The disease usually occurs in people with long exposure to asbestos (a fibrous mineral). This can occur in the following occupations: Plumbers, pipefitters, steamfitters, electricians, insulation workers, carpenters, laborers, boilermakers, welders and cutters, and janitors. Asbestos exposure is also seen in people working in some industries, such as construction, shipbuilding and repairing, chemicals and other manufacturing, railways, trucking, and plastic and rubber manufacturing.

You don’t have to actually work with the material to get asbestosis – people who work alongside the workers in a shipyard may get it too (which might explain L.’s exposure) and also there have been cases of wives of people exposed to asbestos getting exposed themselves through washing their husbands’ work clothes.

Today asbestos is used less (it was replaced with synthetic mineral fibers, such as fiberglass) but it’s still used in the developing world.

Usually it takes at least 10 years of exposure before the disease can manifest.

Asbestos. This mineral is made of fibers, which can be inhaled and cause damage to the lungs.

What causes it?

The asbestos fibers, when inhaled, can do one of 2 things to the lungs:

1. They have a toxic effect on the cells of the lung
2. They cause inflammation in the lung

It’s important to mention that smoking makes this worse, since it damages the body’s ability to get rid of the asbestos fibers.

As a result of the inflammation in the lung, the lung undergoes fibrosis (or scarring) – This means that its normal tissue, which enables us to breath, changes gradually to a connective tissue, that lacks the normal characteristics of the lung.

How does it feel?

This article deals with asbestosis, but it’s important to know that 2 other things can be caused by asbestos exposure as well –

1. Disease in the lung’s coverings
2. Lung cancer

In asbestosis, people who were exposed to the fibers are usually fine for 20-30 years after the first exposure (but the more fibers they were exposed to, the less time it will take for the disease to show). Then the following things can happen -

1. Shortness of breath – They will feel this when they make physical efforts. That’s because the lung can’t provide as much oxygen as it could if it were healthy. The shortness of breath tends to progress in severity with time, even without further exposure to the fibers.
2. Inspiratory crackles – These are coarse sounds the doctor can hear when they put the stethoscope on the chest to listen to the lungs.
3. Clubbing – Clubbing is raising of the fingernails. It can happen in other diseases as well.

An example of clubbing in the fingers.

With severe cases, heart failure can also occur.

How is it discovered?

There are 3 things that can help in diagnosing asbestosis:

1. A story of exposure to asbestos
2. Chest X-rays or CT scans that show the fibrosis in the lungs
3. Pulmonary function tests – These are tests that check the function of the lungs and will show that they don’t work efficiently.

How is it treated?

There is no cure for asbestosis. Stopping the exposure to asbestos will help, but the disease can progress even after the exposure is stopped. The following things can help -

1. Oxygen may be given to ease the shortness of breath.
2. Stopping smoking – It can help, since smoking makes the disease worse.
3. Treatment on time of respiratory infections – Since they tend to complicate more in people with lung problems. Also vaccines should be given when possible.

What happens after treatment?

That depends on many things, such as the duration and the extent of exposure to asbestos. Some people will have a milder disease than others.

The bottom line – How do I avoid it?

The best way to prevent asbestosis is to minimize exposure to asbestos. In the United States, by law, a worker’s exposure to asbestos may not exceed 0.1 fiber per cubic centimeter of air. Federal law requires employers in industries that work with asbestos products (such as construction and shipyard industries) to monitor exposure levels, create regulated areas for asbestos work, and provide their employees with appropriate training, protective gear such as face masks, and decontamination hygiene areas.

This movie, from 1959, created by the Bureau of Mines of the US talks about the “wonders” of asbestos. Since then, of course, its use has gone down.

For further reading you can visit this AsbestosHUB, which provides updated information about asbestos and asbestos-related diseases.

Related posts:

1. Pleural Mesothelioma – Cancer of The Lungs Caused by Exposure to Asbestos
2. Deep Vein Thrombosis – Clots in Your Veins Which Can Travel To Your Heart and Lungs
3. As Seen on Grey’s Anatomy – EX-Vivo Lung Transplant – A New Hope For Patients