When Richard Casten was planning a trip to the Mount Everest base camp in Tibet, his doctor had some simple advice: Don't do it. Casten, 71, has had severe asthma all his life and should not be able to survive on the low oxygen supply available at high altitudes.
Casten makes a habit of the impossible. Though his lung function is only 30 percent of normal, he is an avid tennis player and a globetrotter drawn to high altitudes. Flat landscapes are "boring. I love mountains and glaciers," he explains. A lifelong sports fanatic, he has always been chasing after a ball of some kind. One of the saddest days of his life was when pitcher Tommy John retired from baseball at age 46. "I was about the same age as him. For the first time, I realized I was never going to be one of the Yankees," says Casten, who is the D. Allan Bromley Professor of Physics at Yale University.
Though Geoffrey Chupp, MD, director of the Yale Center for Asthma and Airways Disease (YCAAD), could not dissuade Casten from making the Everest trip, he did manage to monitor his patient during the adventure. They agreed that Casten would text Dr. Chupp updates on his activity and readings from his pulse oximeter, a device that clips onto a fingertip. A normal pulse oximeter reading would be about 97 percent.
Casten sent his texts as he ascended to the base camp. "At 3 a.m. I get a text from him at 12,300 feet. His oxygen saturation numbers are down in the 70s, which for us in the intensive care unit would be a crisis," remembers Dr. Chupp. "That's not compatible with life." Though most of the trip to the 16,900-foot base camp was by vehicle—including travel over mountain passes at 17,300 feet, Casten's number sank as low as the high 40s. The toughest part was a steep climb to a viewpoint at the base camp.
Doctor kept close tabs
He advised Casten to use oxygen from a tank, but the supply of oxygen available provided enough for only short periods of relief. Nevertheless, Dr. Chupp kept close tabs on Casten with warnings like, "Not sure you'll handle 18,000 (feet) very well." Casten did struggle during the trip, but made it through by stopping frequently to get his breath as he climbed and by making an effort to exhale forcefully—a trick he's learned to help him empty his lungs more thoroughly, allowing new air to enter. "My guide thought I was going to kill myself," he says. Casten and his wife, who joined him on the trip, were calm. "She knows I know exactly what I can do," he explains.
While he does monitor his asthma, the physicist says his remarkable ability to get by with far less oxygen than most of us need does not pique his own scientific curiosity. "I have enough trouble understanding atomic nuclei," he says with a smile.
But Dr. Chupp says, "I definitely believe that his ability as a physicist to analyze what's happening with his breathing from a mechanical perspective has resulted in him developing breathing exercises or techniques that allow him to maintain an incredibly active lifestyle."
Unfortunately, that lifestyle prevents Casten from benefitting from some of the innovative therapies offered at the YCAAD, one of the leading research centers on asthma nationwide. For example, newer biologic therapies require frequent injections. Casten, who describes himself as being on "every committee known to man" in the world of physics, is flying off to conferences too often to maintain the regimen, though Dr. Chupp is excited about a new drug that will soon be available and require a dosage only every three to four months.
Biology drives asthma therapy
The YCAAD is one of the few in the country that can explore the characteristics of a patient's asthma on a personalized level. An initial evaluation includes dissecting cells from a sputum sample to characterize the inflammatory response. Patients will also take blood tests and have a physiological analysis of their lung function. "By understanding the biology of their disease, we can determine what therapy is best," says Dr. Chupp.
Along with the high-tech therapies the center offers, close communication between doctor and patient is essential in a disease that requires day-to-day management. Casten is not the only patient who communicates with Dr. Chupp frequently. Lauren Cohn, MD, the center's co-director, notes that she communicates frequently with patients who have questions about managing their medications during cold and flu season. "It's amazing how exhausting it is for them," she says.
"I think the burden of disease on these people is just massively underestimated," says Dr. Chupp. He's seen patients lose jobs because of frequent sick days and people who have bone damage in their forties because of steroid use. On the other hand, Dr. Chupp talked about his own 17-year-old son, a cross-country runner and tuba player with asthma. There is a lesson in that and in the remarkable adventures of Rick Casten. "If you take care of your disease properly, even with severe disease you can have an amazing life," says Dr. Chupp.
Casten flips through some photos of his trip: a soaring Buddhist monastery, postcard blue skies, his own smiling face with Everest rising up behind him. "It was a struggle," he says. "But it was worth it."
To make an appointment at the Yale Center for Asthma and Airway Diseases call 203-785-4198.