The view from inside: one cell’s harrowing experience with lung disease

These past few days have been chaotic, but calm has finally set in. A few days ago, my home was infiltrated by particles of asbestos — a type of mineral that builders widely used as an effective insulator until researchers discovered that it causes cancer and other illnesses. To protect us, the body set off a storm of inflammatory proteins, dispersing them like confetti and bringing intolerable heat and a destructive flood.

Now that the threat is gone, we can start healing the damaged tissue around me. I notice some scar tissue in the interstitium, where it blocks the gas exchange path. The interstitium is the area between the air sacs and the blood vessels. I’m filled with dread because I know that the scar tissue here to stay. From this point forward, my job will be an uphill battle.

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Interstitial lung disease (ILD) is an umbrella term for a group of diseases that cause inflammation and subsequent scarring of the interstitium — a space that needs to be clear of obstructions for effective gas exchange.

There’s no single cause for ILD, but contributing factors include smoking, family history, autoimmune conditions, exposure to environmental pollutants and radiation therapy. These injuries cause an abnormal healing response in people diagnosed with ILD.

Normally, the tissue gets repaired to its pre-injury state, but those with ILD experience scarring and thickening of the lung tissue. The air sacs, the surrounding tissue and the capillaries get irreversibly damaged. As the disease progresses, breathing becomes increasingly difficult due to lung stiffness and impaired gas exchange.

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A few days pass, and we get another exposure to asbestos. The cycle of inflammatory storms and scarring repeats itself. I pray that each onslaught will be the last, but I’m proven wrong every time. The scar tissue accumulates mercilessly.

My ability to exchange gas has plummeted because I’ve become hardened and tough. My body no longer fills with as much air. Things I used to be able to do with ease now demand my full efforts.  

My breaths are frequent and shallow, as if in a panicked state. I worry that soon, I will no longer be able to provide oxygen to the blood and that this will have devastating effects on the rest of the body. They are all counting on me, and I do not plan on disappointing.

My body thrashes as the lungs protest the presence of asbestos. I hope these coughs tell the brain to avoid exposure to the asbestos, but I don’t think it understands. After all, almost anything can cause a cough.

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Because ILD includes many disease types, patients experience the disease differently, with varying severity and symptoms. Some common symptoms include shortness of breath, dry cough, fatigue, unexplained weight loss, discomfort in the chest and bleeding in the lungs.

These symptoms aren’t specific to ILD and are often present in other lung conditions, making diagnosis difficult. Some tools for diagnosis include antibody detection through blood tests, CT (computed tomography) scans, lung function tests such as spirometry, and lung biopsies.

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Finally, some relief! Although the asbestos persists, it’s accompanied by a corticosteroid drug that decreases the intensity of the inflammatory response. I notice that the scar tissue formation has slowed, but it hasn’t stalled due to the continued presence of asbestos.

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Because the scarring is permanent, clinicians typically focus on slowing the disease’s progression and managing its symptoms. Treatment options include corticosteroid drugs to target ILD’s characteristic inflammation, and oxygen therapy and pulmonary rehabilitation to assist breathing. A lung transplant for those with severe ILD is also an option.

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Although I’m grateful for the relief, this feels more like a band-aid solution as opposed to a permanent one. As the days go on, I continue to deteriorate. If only I could levitate out of the airways and communicate with the doctor. If only they would just stop inhaling asbestos. If only I could withstand the injuries a bit more. If only ….

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Due to the many different types of ILD, treatment for the disease also varies. Many factors cause ILD and eliminating these triggers would be among the most effective treatments. If left untreated ILD can cause respiratory failure, which is characterized by low oxygen levels in the blood and increased pressure in the lung’s blood vessels. This can subsequently lead to heart failure and death.

A challenge in treating ILD is clarifying the subtype of the disease. A definite diagnosis would allow for targeted treatment, improving the patient’s outcomes and quality of life. Unfortunately, the only way to provide a definite diagnosis is through lung biopsies. Current methods for acquiring lung tissue are either inadequate or unsafe. 

Human medical researcher Dr. Anderson Tyan and veterinary scientist Dr. Julia Montgomery are collaborating with engineer Jim Boire to develop practical solutions to health care challenges. Each comes from a different background and each brings a unique skillset to the table.

The team is working to develop a new transbronchial lung biopsy tool and they’re working to validate the tool using a porcine lung model. They aim to overcome current limitations in diagnosing and treating ILD by acquiring histologically relevant samples, and ultimately improving health outcomes in both human and animal patients.

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Just as I’m about to give up, I feel my body ascend, high up into places I’ve never wandered before. What is going on? I see the daylight — I must have made it out of the body. 

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Bonnie Yang of Saskatoon, Sask., is a Physiology and Pharmacology student in the USask College of Arts and Science whose work as a summer research student in 2022 was funded by the USask Respiratory Research Centre. Her story is part of a series of articles written by WCVM summer research students.