U.S. Veterans Deserve Better Diagnosis and Treatment of Lung Disease
U.S. Veterans Deserve Better Diagnosis and Treatment of Lung Disease
February 22, 2023
Linda Singh (left) talks to Jan De Backer about her deployment and breathing issues
Major General Linda Lee Singh, Ret., Maryland’s first African-American and first woman Adjutant General, has been fighting a laundry list of respiratory ailments since her deployments in Afghanistan and Bosnia. She has been frustrated with a siloed medical system that seems unable to accurately diagnose and effectively treat her persisting maladies that have negatively impacted her quality of life.
For years, Singh was diagnosed with exercise induced asthma, but she suspected that this diagnosis didn’t fully explain her breathing issues. Exercise-induced asthma (or exercise-induced bronchoconstriction) is triggered by strenuous exercise and characterized by the lung airways narrowing, causing shortness of breath, wheezing, coughing, and other symptoms during or after exercise.
Earlier this year, she spoke to Jan De Backer, the founder and CEO of Fluidda, a company leveraging artificial intelligence to interpret CT scans to improve the diagnosis and treatment of lung disease. She explained that she continued to look for a holistic explanation that could explain the “root” of her problems and hopefully provide a more effective treatment.
De Backer connected Singh with Dr. Noah Lechtzin, a pulmonary and critical care medicine physician who directs the Adult CF program and the neuromuscular pulmonary clinic at Johns Hopkins. He is an expert in the treatment of cystic fibrosis, pulmonary complications of neuromuscular disease and the care of critically ill patients in the Medical ICU.
In addition to the standard CT scans, De Backer provided Dr. Lechtzin with more detailed, three-dimensional images created by artificial intelligence interpreting the traditional CT scans. De Backer observed that the additional detail shows what traditional scans missed: the exposure to toxic environments caused many more airways to collapse in the burn pit exposure, which resulted in air-trapping.
Armed with these detailed, animated images and Singh’s background story, Dr. Lechtzin observed that Singh’s case did not suggest exercise induced asthma.
“This is a healthy, active individual who has been athletic all her life,” Dr. Lechtzin observed. “However, after a number of exposures during deployment abroad, she develops debilitating shortness of breath symptoms and never really responded to treatments for asthma.”
Dr. Lechtzin noted that the clinical story and lack of response to asthma treatments suggested a bronchiolitis disorder. Bronchiolitis can be a common lung condition marked by inflammation and congestion in the small airways (bronchioles) of the lung. Bronchiolitis is often caused by a virus and symptoms are similar to common cold symptoms, but often progresses to coughing, wheezing and sometimes difficulty breathing. This type of bronchiolitis is usually short-lived and improves on its own. Constrictive bronchiolitis is a relatively uncommon lung disease in which small airways become scarred. It has been reported to occur after toxic exposures such as burn pits.
Constrictive bronchiolitis is difficult to treat but sometimes responds well to long-term macrolide antibiotic intervention, according to Dr. Lechtzin. He recommended Azithromycin, a popular antibiotic medication that treats a variety of health conditions used to treat certain bacterial infections, such as bronchitis and pneumonia. He stressed that this is usually a well-tolerated, safe intervention.
De Backer and Dr. Lechtzin suspect that there are likely countless other veterans and others like firefighters who have been exposed to dangerous environments linked to a host of respiratory illness and diseases who need better diagnosis and treatment.
Dr. Lechtzin noted that the detailed, 3-D images provided by Fluidda provide doctors with more objectivity to diagnose and treat these pulmonary issues.
“The standard is to perform a scan and a radiologist looks at it and describes what they see which is certainly useful, but very subjective and can vary based on the radiologist’s experience and how they describe things,” Dr. Lechtzin said. “As a pulmonologist, I certainly look at the scans myself and form my own opinions, but often times, if it is ordered by a non-pulmonologist or seen by a non-pulmonologist, depending on how things are described, it can shape your view dramatically.”
He added that the images developed with Fluidda’s technology gleans much more detail from the CT scans than what you’d get from a radiologist’s description, ultimately providing more objectivity.
“We see this often,” De Backer confirms. “Reports from Linda’s CT scan suggested her airways were normal apart from some nodules that luckily didn’t move over time. So, the report shows lung functions are normal, but clearly Linda’s symptoms tell a different story.”
DeBacker stresses the importance of enhancing diagnostics to improve diagnostics and clinical outcomes. In the future he hopes to leverage AI to better interpret conventional tools like spirometry and CT scans.
“This will also help assess the effectiveness of antibiotics and CPAP on lung functions,” he says. “Hopefully we’ll observe symptoms reduced and exercise tolerance increase. We’ll need to work closely with physicians to follow up and learn from their patients’ experiences.”
U.S. Veterans Deserve Better Diagnosis and Treatment of Lung Disease
U.S. Veterans Deserve Better Diagnosis and Treatment of Lung Disease
Major General Linda Lee Singh, Ret., Maryland’s first African-American and first woman Adjutant General, has been fighting a laundry list of respiratory ailments since her deployments in Afghanistan and Bosnia. She has been frustrated with a siloed medical system that seems unable to accurately diagnose and effectively treat her persisting maladies that have negatively impacted her quality of life.
For years, Singh was diagnosed with exercise induced asthma, but she suspected that this diagnosis didn’t fully explain her breathing issues. Exercise-induced asthma (or exercise-induced bronchoconstriction) is triggered by strenuous exercise and characterized by the lung airways narrowing, causing shortness of breath, wheezing, coughing, and other symptoms during or after exercise.
Earlier this year, she spoke to Jan De Backer, the founder and CEO of Fluidda, a company leveraging artificial intelligence to interpret CT scans to improve the diagnosis and treatment of lung disease. She explained that she continued to look for a holistic explanation that could explain the “root” of her problems and hopefully provide a more effective treatment.
De Backer connected Singh with Dr. Noah Lechtzin, a pulmonary and critical care medicine physician who directs the Adult CF program and the neuromuscular pulmonary clinic at Johns Hopkins. He is an expert in the treatment of cystic fibrosis, pulmonary complications of neuromuscular disease and the care of critically ill patients in the Medical ICU.
In addition to the standard CT scans, De Backer provided Dr. Lechtzin with more detailed, three-dimensional images created by artificial intelligence interpreting the traditional CT scans. De Backer observed that the additional detail shows what traditional scans missed: the exposure to toxic environments caused many more airways to collapse in the burn pit exposure, which resulted in air-trapping.
Armed with these detailed, animated images and Singh’s background story, Dr. Lechtzin observed that Singh’s case did not suggest exercise induced asthma.
“This is a healthy, active individual who has been athletic all her life,” Dr. Lechtzin observed. “However, after a number of exposures during deployment abroad, she develops debilitating shortness of breath symptoms and never really responded to treatments for asthma.”
Dr. Lechtzin noted that the clinical story and lack of response to asthma treatments suggested a bronchiolitis disorder. Bronchiolitis can be a common lung condition marked by inflammation and congestion in the small airways (bronchioles) of the lung. Bronchiolitis is often caused by a virus and symptoms are similar to common cold symptoms, but often progresses to coughing, wheezing and sometimes difficulty breathing. This type of bronchiolitis is usually short-lived and improves on its own. Constrictive bronchiolitis is a relatively uncommon lung disease in which small airways become scarred. It has been reported to occur after toxic exposures such as burn pits.
Constrictive bronchiolitis is difficult to treat but sometimes responds well to long-term macrolide antibiotic intervention, according to Dr. Lechtzin. He recommended Azithromycin, a popular antibiotic medication that treats a variety of health conditions used to treat certain bacterial infections, such as bronchitis and pneumonia. He stressed that this is usually a well-tolerated, safe intervention.
De Backer and Dr. Lechtzin suspect that there are likely countless other veterans and others like firefighters who have been exposed to dangerous environments linked to a host of respiratory illness and diseases who need better diagnosis and treatment.
Dr. Lechtzin noted that the detailed, 3-D images provided by Fluidda provide doctors with more objectivity to diagnose and treat these pulmonary issues.
“The standard is to perform a scan and a radiologist looks at it and describes what they see which is certainly useful, but very subjective and can vary based on the radiologist’s experience and how they describe things,” Dr. Lechtzin said. “As a pulmonologist, I certainly look at the scans myself and form my own opinions, but often times, if it is ordered by a non-pulmonologist or seen by a non-pulmonologist, depending on how things are described, it can shape your view dramatically.”
He added that the images developed with Fluidda’s technology gleans much more detail from the CT scans than what you’d get from a radiologist’s description, ultimately providing more objectivity.
“We see this often,” De Backer confirms. “Reports from Linda’s CT scan suggested her airways were normal apart from some nodules that luckily didn’t move over time. So, the report shows lung functions are normal, but clearly Linda’s symptoms tell a different story.”
DeBacker stresses the importance of enhancing diagnostics to improve diagnostics and clinical outcomes. In the future he hopes to leverage AI to better interpret conventional tools like spirometry and CT scans.
“This will also help assess the effectiveness of antibiotics and CPAP on lung functions,” he says. “Hopefully we’ll observe symptoms reduced and exercise tolerance increase. We’ll need to work closely with physicians to follow up and learn from their patients’ experiences.”