UM Doctor Explores Alternative To Existing Ventilator Treatment for Coronavirus

Apr 8, 2020

Governors and public health officials across the country have fought tirelessly for access to more ventilators. Coronavirus attacks a patient's respiratory system and ventilators can be essential in supporting healthy breathing. 

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A University of Miami pulmonologist is studying a new treatment that could reduce the need for ventilators.

 

Dr. Roger Alvarez was seeing a COVID-19 patient at the University of Miami UHealth Tower who had trouble getting oxygen. Alvarez tried a treatment called nitric oxide therapy.

 

“I called the FDA and got approval to do what’s called an emergency expanded access use. And we gave him the nitric oxide, five days later he was discharged from the hospital without oxygen needed.” 

 

Dr. Alvarez spoke with Luis Hernandez on Sundial about the treatment and whether it could be used on a larger scale. 

 

 

WLRN: How does COVID-19 attack the lungs? 

ALVAREZ: Well, I have to tell you that we are still learning more and more every day around the country and around the world about how this disease is somewhat unique. But like other respiratory viruses, the coronavirus that causes COVID-19 enters through the lining of the respiratory system. So the respiratory system starts in your nose in your nasal passage. 

Dr. Roger Alvarez, a University of Miami pulmonologist, is studying a new treatment that could reduce the need for ventilators.

It goes all the way down into the lungs, into the small sacs of air and it gets into the lining, reproduces there initially before you get an immune system response.  It really reproduces very rapidly. And then after being in your upper airway for a while, several days later, descends down into your actual lungs and where it seems to infect both the lining of the lung what we call the epithelium and then also the blood vessels in the lung do seem to be affected. 

 

So nitric oxide comes into play now. And we have to be clear, this is very different from nitrous oxide. So people, understand the difference between the two. We think of nitrous oxide, that's what we get when we go to the dentist. What does nitric oxide do exactly? How does it help people who, again, are not getting enough oxygen? 

 

One of my favorite things about being a nitric oxide biologist is getting to start every conversation with a joke about nitrous oxide gas. That's a good gimme that I get. And it's certainly no laughing matter. Forgive the pun. So basically, nitric oxide is made by our bodies in a variety of cells, mostly in our blood vessels. That's the primary place. It's also made by some of our white blood cells. And it has a lot of different functions throughout the body in general. 

 

In the blood vessels, it's a signal to the artery, which is basically a tube that's lined by some lining cells that's called the endothelium, and then it's circled around by muscle. And the muscle is what allows the blood vessels to constrict and slow down blood flow or open up and allow more blood flow. Nitric oxide is one of the most important signals to that muscle to relax and open up to allow more blood flow. Nitric oxide as a therapy has been approved for many years by the FDA for the treatment of little babies that have a condition called persistent pulmonary hypertension of the newborn. And it's life-saving therapy for those babies. 

 

And it's used around the world as a rescue therapy, meaning when people who have severe pneumonia with very low oxygen and they're placed on the ventilator, sometimes even the ventilator is not enough. In that case, we add nitric oxide. And by opening up those arteries in the lung, especially in the areas of the lung where the oxygen is being delivered, it brings the blood close to the air.  So more surface area for that and more oxygen in the blood.  

 

How do we know that the therapy worked and this wasn't just a patient who recovered on their own? 

 

That is a wonderful question that I'm so glad you're asking. The reality is, like many other therapies, we don't know. And we don't know that's the reason that he recovered. You're absolutely right. And so when we do therapies like this, there's this effect sometimes called the Lazarus effect. Someone looks like they're gonna die. We give them medicine. They improve. We assume it was the medicine. If they die or die or get worse, we assume that it happened despite the medicine. And the only way we can answer your question is to do a randomized controlled trial. And so that's what I'm currently actively working on with support from the University of Miami, who's provided me a small grant to actually do a randomized trial.