Life Lessons

Life Lessons: Nicotine patches and chronic lung disease

Doctors​ ​believe​ ​there​ ​is​ ​some​ ​good​ ​to​ ​be​ ​found​ ​in​ ​nicotine,​ ​the​ ​highly​ ​addictive​ ​drug​ ​in tobacco​ ​products.​ ​Lung​ ​experts​ ​at​ ​​The​ ​Ohio​ ​State​ ​University​ ​Wexner​ ​Medical​ ​Center​​ ​are​ ​testing​ ​whether​ ​nicotine can​ ​help​ ​people​ ​with​ ​a​ ​chronic​ ​inflammatory​ ​lung​ ​disease​ ​called​ ​sarcoidosis.

“It’s​ ​tricky​ ​because​ ​it​ ​mimics​ ​other​ ​diseases," ​said​ ​​Dr.​ ​Elliott​ ​Crouser​,​ ​a​ ​pulmonologist​ specializing​ ​in​ ​sarcoidosis​. "It’s​ ​frequently​ ​misdiagnosed.​ ​Sarcoidosis​ ​can​ ​look​ ​like​ ​lung​ ​nodules, pneumonia,​ ​scar​ ​tissue,​ ​even​ ​lung​ ​cancer.​ ​It​ ​can​ ​involve​ ​other​ ​vital​ ​organs,​ ​and​ ​it​ ​differs​ ​from​ ​one​ ​person​ ​to​ ​the next.”​

Left​ ​untreated,​ ​the​ ​disease​ ​can​ ​cause​ ​severe​ ​lung​ ​damage​ ​and​ ​even​ ​death.​ ​Unlike​ ​most​ ​lung​ ​diseases,​ ​the​ ​main symptom​ ​isn’t​ ​shortness​ ​of​ ​breath,​ ​but​ ​debilitating​ ​fatigue.​ ​Current​ ​treatments​ ​such​ ​as​ ​steroids​ ​often​ ​have​ ​side effects​ ​harsher​ ​than​ ​the​ ​symptoms​ ​of​ ​the​ ​disease​ ​itself.

“We​ ​can’t​ ​use​ ​the​ ​medications​ ​for​ ​very​ ​long​ ​before​ ​these​ ​side​ ​effects​ ​occur.​ ​They​ ​can​ ​be​ ​severe,​ ​such​ ​as​ ​the development​ ​of​ ​osteoporosis,​ ​cataracts,​ ​diabetes​ ​or​ ​high​ ​blood​ ​pressure​ ​and​ ​complications​ ​related​ ​to​ ​those,” Crouser​ ​said.​ ​“We​ ​need​ ​better,​ ​more​ ​tolerable​ ​options.”

So​ ​Crouser​ ​is​ ​leading​ ​a​ ​​clinical​ ​trial​​ ​at​ ​Ohio​ ​State​ ​Wexner​ ​Medical​ ​Center​ ​to​ ​test​ ​nicotine​ ​patches,​ ​normally​ ​used to​ ​help​ ​people​ ​stop​ ​smoking,​ ​as​ ​a​ ​potential​ ​treatment​ ​for​ ​sarcoidosis.​ ​A​ ​small​ ​initial​ ​study​ ​of​ ​the​ ​patches​ ​showed some​ ​benefit,​ ​and​ ​now​ ​Crouser​ ​is​ ​conducting​ ​a​ ​larger,​ ​randomized​ ​trial.​ ​The​ ​Cleveland​ ​Clinic​ ​is​ ​also​ ​participating in​ ​the​ ​study.

 “Why​ ​nicotine?​ ​Around​ ​2000,​ ​we​ ​learned​ ​two​ ​things.​ ​There​ ​was​ ​new​ ​evidence​ ​that​ ​nicotine​ ​is​ ​an anti-inflammatory,​ ​and​ ​from​ ​other​ ​studies​ ​we​ ​discovered​ ​smokers​ ​were​ ​less​ ​likely​ ​to​ ​get​ ​sarcoidosis,”​ ​Crouser said.​ ​“So​ ​we’re​ ​testing​ ​whether​ ​nicotine​ ​can​ ​be​ ​a​ ​solution.​ ​We​ ​hope​ ​people​ ​will​ ​actually​ ​get​ ​a​ ​secondary​ ​benefit​ ​- not​ ​only​ ​will​ ​their​ ​lung​ ​disease​ ​get​ ​better,​ ​but​ ​they’ll​ ​feel​ ​more​ ​energized​ ​and​ ​have​ ​better​ ​quality​ ​of​ ​life.”

Trial​ ​participants​ ​are​ ​randomized​ ​to​ ​receive​ ​a​ ​patch​ ​with​ ​nicotine​ ​or​ ​a​ ​placebo​ ​for​ ​seven​ ​months.​ ​Researchers​ ​will evaluate​ ​lung​ ​function​ ​using​ ​computerized​ ​axial​ ​tomography​ ​(CAT​ ​scans)​ ​along​ ​with​ ​computer​ ​models​ ​to​ ​monitor disease​ ​progression​ ​or​ ​improvement.

No​ ​one​ ​knows​ ​exactly​ ​what​ ​causes​ ​sarcoidosis,​ ​but​ ​experts​ ​believe​ ​it’s​ ​related​ ​to​ ​an​ ​environmental​ ​exposure. Because​ ​symptoms​ ​vary​ ​widely,​ ​it’s​ ​still​ ​unclear​ ​what​ ​triggers​ ​the​ ​disease.​ ​Many​ ​patients​ ​can​ ​recover​ ​from sarcoidosis, ​or​ ​go​ ​into​ ​remission.​ ​For​ ​some,​ ​it’s​ ​a​ ​chronic​ ​condition.

“There​ ​isn’t​ ​a​ ​lot​ ​of​ ​data​ ​on​ ​the​ ​disease​ ​but​ ​we​ ​are​ ​learning​ ​more​ ​about​ ​it.​ ​We​ ​know​ ​black​ ​women​ ​are​ ​at​ ​higher risk​ ​but​ ​we​ ​don’t​ ​know​ ​why,”​ ​Crouser​ ​said.​ ​“We’re​ ​seeing​ ​more​ ​cases​ ​diagnosed​ ​overall.​ ​We​ ​think​ ​that​ ​might​ ​be from​ ​increased​ ​awareness​ ​of​ ​the​ ​disease​ ​among​ ​the​ ​healthcare​ ​community​ ​and​ ​the​ ​use​ ​of​ ​more​ ​sensitive screening​ ​tests,​ ​such​ ​as​ ​CAT​ ​scans,​ ​which​ ​improves​ ​the​ ​detection​ ​of​ ​the​ ​disease.​

"It​ ​is​ ​also​ ​possible​ ​that something​ ​in​ ​the​ ​environment​ ​is​ ​triggering​ ​more​ ​cases​ ​of​ ​sarcoidosis," he said.​ "​More​ ​research​ ​is​ ​needed​ ​to​ ​better understand​ ​the​ ​disease​ ​and​ ​to​ ​improve​ ​the​ ​current​ ​standards​ ​of​ ​care.”


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