University of Pennsylvania Health System

Lung Transplant Update | Penn Medicine

Tuesday, September 9, 2014

Understanding Chronic Obstructive Pulmonary Disease (COPD)

According to the American Lung Association, chronic obstructive pulmonary disease (COPD) affects approximately 12.7 million people in the United States. This disease, which is actually a combination of two separate conditions, emphysema and chronic bronchitis, accounts for more than half of the single lung transplants in the United States.

As with any disease of the lungs, understanding how the illness works inside the body can sometimes help you cope with some of the symptoms of the disease while you await transplantation. Before we get started, it might be helpful to review the different parts of the lungs, how they work and what they do. If you need a quick refresher, check the information we shared in an article earlier this summer titled, “How Do the Lungs Actually Work?

Since COPD is sometimes a mixture of emphysema and chronic bronchitis, we’re going to talk about these two conditions separately.

Emphysema, as a part of COPD, means the air sacs (alveoli) are damaged. As these fragile compartments of air break down, less oxygen is absorbed when you breathe in. The walls of the air sacs become loose, and the overall surface area of the alveoli decreases. This reduces the surface area and the amount of oxygen that can be absorbed into the body.

The other aspect of COPD, chronic bronchitis, means that the bronchi (tubes leading to the air sacs) are repeatedly or constantly inflamed. With inflamed bronchi, the lungs produce unnecessary liquid in the form of mucus, and the tubes that pass air back and forth to the lungs become smaller. Bronchitis also means that more coughing will occur so that mucus will be removed from the body.

How Is COPD Diagnosed and What Does a Diagnosis Mean?

Since COPD causes visible damage to the lungs as well as inflammation inside the lungs, a few imaging tests and physical tests can be done to figure out whether or not a patient has COPD. X-rays or CT scans of the lungs may be taken to see damage to the alveoli (a result of the emphysema in COPD). Another test is a spirometry test, which simply and painlessly examines breathing function.

What Should I Do After a COPD Diagnosis?

As with any serious health condition, it’s important to partner closely with your health care team to effectively treat the symptoms of COPD and to monitor how frequently the symptoms occur as well as how difficult the symptoms are for you to tolerate. Some common symptoms of COPD are tightness in the chest, wheezing and coughing, mucus (fluid) expelled when coughing, and frequent chest colds.

Over time, COPD symptoms typically get worse – especially if not treated properly. While you wait for lungs to become available, there are a few simple steps that may help reduce the severity of the symptoms and help prepare your body for transplant surgery.

  1. If you have been diagnosed with COPD and still smoke, it’s important to try to quit smoking. Stopping smoking slows the progression of COPD and stops the constant scarring and irritation of the lungs that smoking causes.
  2. While it may be difficult, safely increasing physical activity can help lung function tremendously. Exercise helps to strengthen the muscles of the respiratory system, and help overall longevity as well. Talk with your transplant coordinator to learn how you can add activity to your daily routine in ways that are safe with your lung condition.
  3. Maintaining a healthy diet is important to overall health. While this is important for everyone, for patients awaiting lung transplant who are diagnosed with COPD it’s especially important.
Because eating can sometimes be difficult for people with COPD, your physician may recommend nutritional supplements. If your current weight is higher than what is considered healthy for your height and body frame, it’s possible that changing your food choices and losing weight could relieve pressure on your lungs and decrease your discomfort.

For more information about COPD or steps you can take to maintain your health and prepare for transplant, please contact your Penn Lung Transplant nurse practitioner.


Friday, September 5, 2014

Penn Lung Transplant Travels Down Under

Thanks to an international traveling scholarship from the International Society for Heart and Lung Transplant nurse practitioner, Kevin Carney, MSN, CCTC, traveled to Victoria, Australia to expand his knowledge about lung transplantation and share his expertise with the Lung Transplant team at The Alfred Hospital.

Kevin’s interest in the pioneering work of the lung transplant team at The Alfred Hospital began in 2007. While he was doing research about the clinical management of a potential lung donor, the names of The Alfred Lung Transplant team members came up over and over again as their clinical experiences and observations were shared in several peer-reviewed medical journals.

The following year, Kevin traveled to the the 2008 ISHLT annual meeting in Boston and attended a symposium on donor management that was chaired by one of the leaders of The Alfred Lung Transplant team, Professor Greg Snell. At the end of the session, Kevin introduced himself to Professor Snell, and he met another Alfred Lung Transplant team member, Bronwyn Levvey – both of whom were generous with their time and happy to answer Kevin’s questions.

Since his initial meeting, Kevin had multiple opportunities to work with Bronwyn through their service on the ISHLT Nursing, Health Science, and Allied Health Council (NHSAH). During the 2011 ISHLT meeting in San Diego, when an announcement was made that the ISHLT would be awarding travel scholarships to members who were interested in expanding their knowledge base, Kevin knew exactly where he’d like to travel to learn more about lung transplantation: The Alfred in Victoria, Australia.

Kevin was awarded the scholarship to work closely with The Alfred Lung Transplant team to expand his knowledge in the following areas: effective donor management strategies, evaluating patients for lung transplantation, postoperative clinical management and outpatient recipient follow-up. Because The Alfred has been at the forefront in the use of lung donors after cardiac death (DCD), Kevin sought to understand the national and regional policies towards DCD management.

In addition to working with the lung transplant team at The Alfred, Kevin’s trip to Australia allowed him an opportunity to meet with the local organ procurement organization, Donate Life, to understand local and national organ donation protocols and policies, and to learn how they partnered with The Alfred Lung Transplant Service.

"After spending three weeks with the Lung Transplant Team at The Alfred, I believe the keys to their success are their multi-disciplinary collaboration and their commitment to clinical research and evidence based practices,” Kevin said.

He was particularly impressed by the detailed algorithms for hemodynamic, respiratory and pain management that were developed by the intensivists with feedback from the bedside nurses and lung transplant team experts.

"I would like to thank everyone who made my visit to The Alfred so successful. Without the support from Greg, Bronwyn and the rest of the Alfred Lung Transplant team, my wife and children, and The Hospital of The University of Pennsylvania's Lung Transplant team, this trip would not have been possible,” Kevin said.

Kevin went on to thank the ISHLT Board of Directors: “It’s so important that the ISHLT encourages their members to pursue the exchange of knowledge -- not only in spirit, but by financially supporting these endeavors.”




Friday, August 29, 2014

Join Us for the September Support Group

Date: Monday, September 8, 2014
Time: 1 to 3 p.m.
Location: Hospital of the University of Pennsylvania, Gates Conference Room
Topic: Open Forum

Our September support group will be an informal, open forum for discussion. Please join us to connect with other lung transplant patients and caregivers. Share, learn, lean on and fortify others who understand the unique rewards and challenges of lung transplantation.

The support group provides an excellent opportunity to celebrate successes, ask questions and get advice about any dilemmas you may be facing.

Join us and make new friends or reconnect with old ones. Come to inspire or be inspired - or just to say hello. Tell us about your summer and plans for the fall.

For more information about the September Lung Transplant Support Group, please contact Christopher C. Erickson, MSW, LCSW, clinical social worker, at christopher.erickson@uphs.upenn.edu or 215-662-4575.

Friday, August 22, 2014

Two Steps to Staying Safe in the Sun

Summer is coming to a close, but the Penn Lung Transplant Program and Penn Dermatology remind you to continue to think of the skin you are in – regardless of the season. Because early intervention for any skin abnormality is the best way to minimize problems, it’s important for everyone to stay vigilant about skin health. For lung transplant recipients, not only is it important, it’s critical to take skin health seriously and to partner with your healthcare providers to protect yourself. You should take every step you can to minimize your risk.

The reason that careful attention to skin is so serious for transplant patients is because some of the medications prescribed to protect transplanted lung(s) increase your risk for developing skin cancer. This is particularly true for anyone who has ever had sunburn. While people with fair skin and light colored eyes are at a higher risk, even those with darker skin tones are vulnerable to skin cancer, so it’s important to take an active role in this part of your healthcare by practicing early detection and skin cancer prevention.

The good news is that it’s easy to do self exams and protect yourself from the sun all year long. If self exams for skin cancer are new to you, the American Academy of Dermatology (ADA) offers an informative three-minute video explaining the steps of an effective self exam and what specifically to look for. Another helpful tool from the ADA is a free download called the Body Mole Map – a way to record moles and track any changes you observe.

Protecting yourself from the sun throughout the year is also easy to add into your daily routine. By simply wearing protective clothing, such as a wide-brimmed hat and long sleeves, and applying sunscreen with an SPF of 15 or above, you can protect your skin from sun-related skin damage.

In addition to these sun smarts, the Penn Lung Transplant team strongly encourages its patients to see a dermatologist within the first six months following their transplant and once a year after the initial appointment. A dermatologist is specially trained to evaluate and treat disorders of the skin, including infections, rashes and skin cancer. Penn dermatologists offer special expertise in treating post-transplant patients and managing their increased risks.

If you would like to see a Penn dermatologist who specializes in caring for transplant patients, 
please call 215-662-2737 for an appointment.