Top Docs Q&A: Carla Lamb
Lamb uses bronchial thermoplasty to treat severe asthma.
This post is part of our Top Docs Q&A series where we ask a physician who was selected as one of our Top Docs questions about their field, current research, and life as a doctor.
Name: Carla Lamb
Hospital Affiliation: Lahey Hospital and Medical Center
Title: Director of interventional pulmonary and assistant professor at Tufts University
Field: Pulmonary Disease
Specialty: Airway disorders, interventional pulmonology, and lung cancer
You are studying the effectiveness of bronchial thermoplasty for patients with severe asthma, what kind of therapy is this?
This isn’t a mainstream form of therapy, but in certain patients, not all patients may be candidates for bronchial thermoplasty and that’s basically applying heat to the airways so they can’t tighten and close. That can reduce the number of exacerbations they have and prevent them from going to the emergency room or being hospitalized.
What does this research look like?
We are part of a multicenter post-marketing trial. The idea behind that, after the initial studies came out and said it was safe, reduced hospitalization, missed days of work, and things like that, they have additional centers see if those results could be reproduced in some way. That data does show, primarily, that we were able to reduce results and persistent benefit over time and the procedure did positively help patients that have severe asthma.
You are also studying the effectiveness of using the IBV Valve System for treating emphysema. How does that work?
Intrabronchial valve, it’s basically made of nickel and titanium, and looks like a very small umbrella. So what we’re doing, is we’re taking patients who have very severe chronic obstructive pulmonary disease (COPD). We typically say a big cause for COPD is tobacco use, so there’s a threshold in the study where if a person has a forced expiratory volume, when they do a breathing test it’s less than 45 percent. Those are the patients that fit the profile of having more severe variation of COPD and they often have daily systems of shortage of breath or are on oxygen therapy as well.
How does that help with emphysema?
The premise of the study is that we believe if a person has emphysema, there are various shapes and sizes of it. So if we do a CAT scan on patients with COPD, they can have the disease in the upper, lower, or the entire lung. So we are looking for patients with severe COPD, who have not smoked for at least four months, and have gone through a pulmonary rehab exercise program so they are the best they can be. We look at their scans, and we are able to use a protocol to determine if their lung involvement is such that we can identify possibly two lobes of lung that are not working up to par. And the idea of the valve is to place three to five of them into a preselected area of the lung that is the least efficient. By doing that, we can divert ventilation onto the lung that is not exchanging oxygen well.
Lahey Hospital uses navigation therapy to treat lung cancer. What is navigational therapy, exactly?
It’s like MapQuest for the lungs. Just like I might punch in a way of getting from point A to point B, we have the same technology to do in a patient who has a nodule, or a spot in the lung that could be a cancer. They are able to map with their CAT scan the point A to point B, and I can use my technology to get us there.
*This interview has been edited and condensed.