By Ivan Robbins, M.D.
I went to medical school and did my residency in Cleveland at Metrohealth Medical Center. At the end of my internship in internal medicine, I knew that I wanted to go into pulmonary/critical care. I went to Vanderbilt University Medical Center for my training from 1994 to 1997 and have remained on the faculty for my entire career.
The first pulmonary hypertension (PH) patient I remember was a young woman with idiopathic pulmonary arterial hypertension (PAH) who was in the intensive care unit. We gave her inhaled nitric oxide and a pulmonary vasodilator, and her pulmonary artery pressure decreased in half. I thought this was truly amazing. We treated her with calcium channel blockers for many years.
When I started taking care of PH patients 26 years ago, there were no PH-specific therapies. The only options for treatment were calcium channel blockers or lung transplant. During my fellowship, intravenous epoprostenol was approved to treat idiopathic PAH and then other forms of PAH.
Treatment and research
I was fortunate to be involved in initial studies that led to approval of the first oral therapy for PAH. Since then, over 10 therapies have been approved for treatment of PAH, alone or in combination. There are now well-recognized guidelines for evaluation and treatment of PAH, which are readily available to any clinician.
Overall, there has been a great increase in awareness of PAH and the availability of multiple treatments for this condition.
I became involved in the Pulmonary Hypertension Association (PHA) when I was a fellow and have attended every biennial meeting since 1996. PHA’s support has helped me and my patients by increasing PH awareness in the medical community and promoting PH research.
Through PHA, I have gotten to know many other health care professionals who have devoted themselves to the care of patients with PH. I have made many good friends along the way. There is a special comradery that comes from caring for patients with a rare disease.
Although we have come a long way, lung transplant remains the only curative treatment for PAH. Other than calcium channel blockers, transplant was the earliest effective treatment for PAH. In fact, our oldest living lung-transplant patient is a woman with heritable PAH whose surgery was 29 years ago.
I am hopeful for the future. New treatments for PAH are evaluated every year. As our understanding of the pathogenesis of this disease grows, I am confident that eventually we will find a cure.
Soon we will be able to target specific therapies to individual patients based on their genetic make-up. Investigators are working to regenerate organs, which could overcome many drawbacks of lung transplant, such as life-long immunosuppression drugs.
The PH field has come a long way since I began my career, and the changes have been truly remarkable.
Ivan Robbins, M.D., of Vanderbilt University Medical Center in Nashville, shares how PH treatment and research have evolved over the course of his career. His story originally appeared in the award-winning December 2020 issue of Pathlight magazine. Pathlight, PHA’s quarterly member magazine, is a benefit of PHA membership. To read more inspirational PH stories and receive a copy of the magazine, join PHA