Can nicotine help treat a lung disease?

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August 29, 2017

When 47-year-old José Serra needed treatment after falling on some ice, he had no idea the scans he had done would also find sarcoidosis, an inflammatory disease that strikes the lungs, lymph nodes and other organs. Unlike most lung diseases, the main symptom isn’t shortness of breath, but debilitating fatigue.

"I was drinking three energy drinks just to make it through the work day,” Serra says.

Lung doctors typically prescribe a steroid or other medications, but the side effects are often worse than the disease itself.

“We can’t use the medications for long before these side effects occur,” says Elliott Crouser, MD, a pulmonologist and sarcoidosis expert at The Ohio State University Wexner Medical Center. “They can be severe, such as osteoporosis, cataracts, diabetes or high blood pressure and complications related to those. We need better, more tolerable options.”

So Crouser is leading a clinical trial to test nicotine patches as a possible treatment.

Why nicotine?

Crouser says nicotine is an anti-inflammatory and studies have shown smokers are less likely to get sarcoidosis. A small initial study using the patches showed some benefit.

“We hope patients will get double benefit – not only could their lung disease get better, but the nicotine can help them feel more energized,” Crouser says.

Trial participants are randomized to get patches with nicotine or a placebo for seven months. Researchers will measure lung function and disease progression or improvement using CAT scans and computer models.

No one knows exactly what causes sarcoidosis, but Crouser and other experts believe it’s related to environmental exposures. Symptoms vary widely, and the disease often mimics other conditions.

“It’s frequently misdiagnosed. Sarcoidosis can look like lung nodules, pneumonia, scar tissue, even lung cancer,” Crouser says. “It can appear in other organs like the heart, brain or liver. It differs from person to person.”