Focusing on the Patient’s Journey Inspires This Stritch Physician-Researcher
Asked why she decided to focus her medical career on patients with cystic fibrosis (CF) and specifically those requiring lung transplants, Dr. Erin Lowery says simply, “The journey of those with CF is unique. Every day is a gift. I enjoy walking with them and making their journey better.”
A transplant pulmonologist and associate professor of Medicine and Pediatrics at Loyola University Chicago’s Stritch School of Medicine, Dr. Lowery is committed to helping adults and children with CF regain their lives. And she does so on a patient-by-patient basis at Loyola University Medical Center’s Cystic Fibrosis Transplant Clinic as well as on a population level through her research funded by the Cystic Fibrosis Foundation and the National Institutes of Health (NIH).
According to the Cystic Fibrosis Foundation’s patient registry, there are approximately 30,000 children and adults with this rare genetic disease in the United States. About 1,000 new cases are diagnosed each year. CF causes severe damage to the lungs, digestive system and other organs; which leads to respiratory failure in 90 percent of patients.
The genesis of Dr. Lowery’s clinical interest was her residency in Internal Medicine within Loyola University Chicago’s Departments of Medicine and Pediatrics. Now board certified in both specialties as well as Pulmonary and Critical Care Medicine, she found herself drawn to adolescents with CF.
“They were coming into their own as individuals and dealing with a chronic illness that threatened their lives. I had many tell me, ‘My parents were told I wouldn’t survive childhood.’ I wanted to help them live longer, more complete lives.”
In the 1950’s, the average lifespan for individuals with CF was five years. Today, the median survival rate is 47 years. One of the contributors is the availability of lung transplants. Many CF patients seek lung transplants to prolong and improve the quality of their lives.
Yet lung transplants are not without serious risks. There can be complications during surgery and even following successful surgery, the body may reject the donor lungs. While the new lungs are healthy, the patient still has CF. The combined complexities of life with CF and transplantation can be extremely stressful physically, emotionally, and financially.
Seeking to ease the burden for patients and their families, Dr. Lowery played an instrumental role in establishing a Cystic Fibrosis Transplant Clinic at Loyola University Medical Center in 2011. Of the seven CF centers in Chicago, Loyola is the only one that combines CF care with lung transplant care. There are only three such CF lung transplant care centers in the country.
“CF patients who undergo lung transplants are very complex to manage. They have transplant issues, gastrointestinal issues, dietary issues, and psychosocial issues. Due to the volume of appointments, they can get lost in the system. Thanks to our clinic and a multidisciplinary care team trained in CF and transplant care, patients now get all of their care in one place—including nutrition and mental health—which simplifies life and gives patients the best outcomes,” Dr. Lowery explains.
One of the things that sets CF transplant patients apart is their age. They are much younger than typical lung transplant patients, who are typically in their 60s and may have idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease (COPD) or other lung illnesses. The youth of CF patients can lead to improved outcomes following lung transplant, says Dr. Lowery.
“My CF patients feel so much better after their transplant, I have to tell them to slow down; your recovery will take six to twelve months. Nutrition and exercise are very important, as are new medications to prevent rejection of their new lungs. Our focus is healthy wellbeing for the rest of their lives. Their focus is going back to school or work without worrying if they can breathe.”
The innovative approach of Loyola’s Cystic Fibrosis Transplant Clinic caught the attention of the Cystic Fibrosis Foundation, which selected Dr. Lowery and the Loyola’s transplant program to participate in their Lung Transplant Consortium in 2017. The CF Foundation tapped Loyola University Medical Center for the three-year appointment based on its 31-year history in lung transplant surgery, superior patient outcomes, and its commitment to CF patients.
“The Foundation believed not enough attention was focused on lung transplantation, a life-saving procedure for many people with CF. The consortium is composed of 10 transplant centers and is intended to improve care through multi-center research and make the transplant referral process smoother. One aim of the consortium is to develop evidence-based guidelines for all CF and transplant centers to providing quality care,” explains Dr. Lowery. She is working on an extension of the more than $400,000 grant to continue this important work.
Always eager to ease the journey of her lung transplant patients, Dr. Lowery applied for—and received—a five-year K23 Career Development Award from the National Institutes of Health (NIH) in 2014. The goal of her research is to gain a better understanding of how organ donors’ alcohol use affects donated lungs, airway inflammation, and outcomes for lung recipients.
“People often don’t consider the health of organ donors. Some donors participate in risky behaviors that led to their demise such as driving under the influence. Very little was known about the impact a donor’s alcohol abuse had on lung transplant recipients,” says Dr. Lowery. “We identified a potential risk factor for which we hope to develop targeted interventions to treat airway inflammation seen in donors with alcohol abuse to allow for improved outcomes after transplant in the recipient.”
Dr. Lowery’s preliminary data revealed strikingly worse outcomes for recipients of alcohol-compromised lungs and more severe primary graft dysfunction after transplantation. “It’s clear we need more research to determine the impact on long-term outcomes and to pave the way for new strategies and interventions to reduce complications and improve outcomes.”
Asked how she juggles her busy CF Transplant Clinic, the Cystic Fibrosis Foundation Lung Transplant Consortium, her NIH research plus her husband and two small children, Dr. Lowery laughs and then gets thoughtful.
“It’s all about the journey.”