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Posted April 06, 2021
Listen to this episode of the Healthy Vitals Podcast.
Listen to Paul Bailey, a registered respiratory therapist, and Sarah Serb, an acute nurse practitioner, discuss COPD prevention and treatment.
Scott Webb: Chronic obstructive pulmonary disease also known as COPD includes chronic bronchitis and emphysema, and is a long-term disease that makes it hard to breathe. COPD affects millions of Americans and is the third leading cause of disease-related death in the us. The good news is COPD is often preventable and treatable. And joining me today to discuss COPD and how Summa health can help is Paul Bailey, he's a registered respiratory therapist, and Sarah Serb, she's an acute nurse practitioner and both work at Summa Health.
This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So thank you both for joining me today. Paul, I'm gonna start with you. What respiratory diseases are classified as COPD?
Paul Bailey: COPD, it's an acronym. It is chronic obstructive pulmonary disease. This is a chronic inflammatory disease of the lungs that causes limitation with air flow, getting out of the lungs. Now, the two most common diseases that fall under COPD, it's chronic bronchitis and emphysema. The symptoms that we would see with these diseases would be, you know, some shortness of breath, coughing. You would have some sputum that you're coughing up. You would also have a lot of wheezing.
These diseases are diagnosed with something called a pulmonary function test. It's a test to measure how well we're able to get air from the inside of the lungs to the outside. And once we do that, we can identify what part of the lung is being affected. These are progressive diseases, meaning that gradually over time, they can continue to get a little bit worse.
But, with that said, we can treat them. We can work on treating the symptoms and we can control the progression and we can slow it down just a little bit. And we can do that by working with your pulmonary team. We can follow a plan and, hopefully, we can minimize the day-to-day symptoms.
Scott Webb: Yeah, so that sounds good. And Sarah, can you tell us a little bit more about emphysema and chronic bronchitis?
Sarah Serb: Chronic bronchitis and emphysema are umbrellaed under COPD, chronic obstructive pulmonary disease. Chronic bronchitis, usually patients present with a chronic productive cough, so coughing up a lot of mucus or sputum. This usually lasts at least two to three months and occurs multiple times over the course of two years.
Symptoms can get worse over time. You can have acute flares, but they usually never go away. And over an extended period of time, this mucus buildup can cause inflammation and scarring of the airways leading to breathing difficulties. Emphysema, usually patients present with gradually worsening shortness of breath, usually starts mild and begins to interfere with daily life and activities.
In more advanced stages, patients may notice decreased alertness, mental status changes, bluish color of your fingertips or your lips, a lot of shortness of breath with exertion. These symptoms are caused by damage to their air sacs in our lungs called our alveoli. Over time, they weaken, they rupture and they're not able to exchange oxygen into our bloodstream like normal alveoli would.
Scott Webb: And so Paul, let's talk about the lasting or long-term effects of COPD on the lungs.
Paul Bailey: With the lungs, I like to describe them like an upside down tree. With your windpipe, your trachea, being the trunk. And then as we go down, we have all these branches. The farther you go in, the farther you go down inside the lungs, the more and more narrow the branches get until ultimately you end at the leaves. And inside the lungs, the leaves are a cluster of little balloons called alveoli. Now emphysema, one part of COPD, emphysema affects the balloons, while chronic bronchitis affects the branches, those small branches especially.
Now, over time as we're exposed to smoke, whether it's from cigarettes or whatever, as we're exposed to smoke, dust, fumes, we cause those little branches, those airways, to become more inflamed and they get kind of stuck like that. They get chronically inflamed. We start losing the elasticity of those branches. So they're easily collapsible.
When that happens, we end up with a roadblock. So as we breathe in air, you know, the air passes through our lungs and gets into our bloodstream, the oxygen gets into our bloodstream and then we exhale CO2. As those branches collapse down, we cause a roadblock for that CO2. So it starts to build up, okay? So that's one part.
Another part is really what emphysema is. Emphysema affects the little air sacs called alveoli. So again, if you think of our tree, the alveoli are the leaves. So those little balloons, those leaves are affected by the dust and dirt and debris that we breathe in. Over time, those little balloons are very delicate. And as that stuff sits in there, it causes those little balloons to deteriorate. They break down and we end up with a big floppy sac. And we just can't get the air movement from that sac. Imagine, you know, taking a rubber balloon and putting it outside in the sun for a couple of days and you come back and you see that balloon and it's kind of misshapen and it's not as stretchy. It's more delicate and it's not as efficient.
So that's really what we're looking at. We have difficulty with the efficiency of getting air out of the lungs. We can take a breath in, but as we go to exhale, again, that air gets trapped. Now, along with that, we're also going to have increases in mucus. We're going to have wheezing. That's really the two most noticeable symptoms that we're going to have, is that wheezing and sputum production.
Scott Webb: And so Sarah, turning back to you, what conditions are you at higher risk for developing if you have COPD?
Sarah Serb: Okay. So some of the conditions you're at highest risk for if you have underlying COPD, which would be chronic bronchitis or emphysema, would be respiratory failure, meaning you have a low level of oxygen in your bloodstream and that is due to the damage of those air sacs in the lungs and the inability to exchange the oxygen, not just oxygen, but also the inability to get rid of or blow off carbon dioxide. So having an elevated level of carbon dioxide in your blood. So respiratory failure, one.
Another one would be an increased risk for acute respiratory infections, pneumonia, whether it be from a bacteria or a virus, bronchitis, upper respiratory infections, heart disease, specifically heart failure, heart attacks from coronary artery disease and some of that is related to the severe lung disease, as well as one of the number one causes of COPD is smoking. So the prolonged tobacco abuse also can cause coronary artery disease and blockages, as far as that goes.
Scott Webb: And so Paul, we've talked about diagnosis, symptoms, lasting effects. Now let's talk about managing and treating COPD.
Paul Bailey: Things we can do to really minimize COPD is, well, one of them is to go back to something that Sarah mentioned and that's smoking. Quitting smoking is one of the single best things we can do to help reduce the progression of COPD. You know, just to throw a number out there, 90% of patients with COPD have some sort of smoking history. So quitting smoking again is probably one of the best things we could do. Again, that is one of the main components to not only the parts and COPD, but it affects our chronic bronchitis, it affects emphysema and our heart. So overall, it's one of the best things we could do, is quit smoking.
Another thing is to make sure that we're taking our medicines as prescribed. We have categories of medicines, rescue inhalers, medicines we would take in a pinch. When we're having those early symptoms, we would take our rescue inhaler. We also have controller medicines that help to manage our day to day symptoms. So making sure that we have those.
And, you know, establishing a relationship with your pulmonary physicians, your pulmonary providers. Staying in contact with those doctors and providers, so we know what is going on with you, how you're feeling on a day to day basis. So those are some of the simple things that we could do.
Scott Webb: Yeah, definitely. And I do a lot of these and in none of them does anyone ever say, "We advise smoking. Please keep smoking." All roads lead back to smoking. And if you are a smoker, please stop, right?
Paul Bailey: Yeah, absolutely. And you know what, it's not just smoking cigarettes, it's, you know, cigars. Vaping is becoming more common. So really taking a close look at that and it's tough to quit. When I understand that when people start smoking, they never had the picture in their head of being, you know, 75 years old and continuing to smoke. When we start smoking, we always have time to quit. It's always something that we want to do. But when it comes time to put them down, it's easier said than done. So we have programs to help people walk through that process.
Scott Webb: Yeah, that's great. And of course, as you say, when people start smoking, they don't envision themselves still smoking 50, 60 years later. It seems like one of those things that, "Yeah, I'm going to do this now. I know it's bad for me, but I'm going to quit. It's not going to be a problem." And then they get older and they get COPD and they have all these complications and, yeah, so good to know that there's assistance available.
Paul Bailey: Yeah, absolutely. And there's actually a lot of free programs. And it's never too late to quit, you know. And while it's difficult, it's not the most difficult thing that we would have to do. I have no doubt in my mind if somebody wanted to quit, we can absolutely help them.
Scott Webb: Yeah. And it does seem like it always comes back to that. If people really want to quit, they usually can, but there's always that, you know, "I should quit, but do I really want to?" So Sarah, as we get close to wrapping up here, what is Summa doing specifically to help those with COPD?
Sarah Serb: So Summa specifically, we have a very good presence with our pulmonary team and the inpatient hospital setting and an outpatient setting in our office. We have a COPD clinic where we see patients who have been diagnosed with COPD or even new patients who are seeking further guidance or diagnosis for possibly having COPD if you're having those symptoms that we've talked about earlier on, you know, wheezing, shortness of breath, cough, mucus production, and you have a history of smoking.
We also have a COPD navigator, Paul Bailey, who helps care coordination for these patients from the hospital to the outpatient setting. We have a program called pulmonary rehab, which is really important for our patients who have COPD. It's an exercise program that is tailored specifically for our COPD patients. You meet with a respiratory therapist, exercise physiologist, physical therapists, and they develop a specific exercise routine and plan of care for you to be able to increase the strength in your chest muscles, teach you breathing techniques; if you're having a flare up, what you can do at home to help with those symptoms, things like that.
We also have a program for in the home for when patients are hospitalized and they go home with home care, it's called CHIP, which stands for COPD Home Intervention Program. This is really just an inpatient to an outpatient setting, where we offer pulmonary rehab in the home, nurse visits, respiratory therapist and PT visits to help keep an eye on patients and hopefully reduce the chance of them ending up back in the hospital and ultimately transition them to our normal pulmonary rehab program.
One of the other very important programs we offer is virtual smoking cessation classes, should be ending up having live classes here soon. With the pandemic, things have changed on how we're operating. Smoking is the number one cause of COPD. It's always a good time to quit, it doesn't matter if you smoked for 10 years or 50 years. It's one of the most important ways we can slow the progression of the disease.
As we've been saying, COPD is chronic, which means it's a lifelong disease. There is no cure for COPD. However, it's very important to understand that it can be controlled. So, although we can't cure it, we can control it. And one way we can control it is to have our patients come see us in the pulmonary office. Do some testing if it needs to be done to kind of see what stage you're at, how bad your symptoms are, and then develop a treatment plan as far as medications that you can take to help with those symptoms, medications, such as inhalers, bronchodilators, medicines that help reduce the mucus production that you have.
Sometimes we also prescribe steroids and antibiotics when patients are having flare ups. And then also transition you into some of these outpatient programs we have like pulmonary rehab as it is one of the only proven treatments for COPD that doesn't only increase your quantity of life, but the quality of life that you have at home as well.
Scott Webb: That's great. And it really sounds like a really comprehensive and multidisciplinary approach. And of course, all roads lead back to stop smoking if you're smoking and if you're having trouble quitting, you know, Summa can help. And again, almost in all cases, it always comes back to quality of life. And as you say, there's no cure for COPD, but there is a way to treat and manage it. And of course, encourage people to stop smoking.
Sarah Serb: Yes, most definitely. And I will add too, for those patients that specifically have emphysema, we do offer some more advanced treatments here at Summa. One of those being an endobronchial valve replacement. And really just in general terms, that's where patients would have emphysema that's specifically in the upper portions of your lungs or maybe just localized to one lobe of your lung or one branch of the tree. And we can put that valve in and kind of wall off that diseased portion of the lung that's not working well. And then, the rest of your lung around it, that's still working, is able to function better without that diseased portion of the lung being there.
Other things we talk about with our patients in the more advanced stages are a lung volume reduction surgery, which is basically surgically removing part of that diseased portion of the lung and then, ultimately, a lung transplant. And those are some things that we partner with outside hospitals here in the area that are transplant centers such as UH or Cleveland Clinic.
Scott Webb: Paul, I'm going to give last word to you. What are the takeaways for people today on COPD?
Paul Bailey: One of the main takeaways would be, again, kind of repeating something that Sarah said, while this disease, unfortunately once you have it, you have it. There's no getting rid of it. But the disease can be managed and it can be maintained. Let's keep what we have and keep what we have healthy.
And again, it's through, you know, working with your team of providers, getting in contact with your pulmonologist and making sure that we're keeping up with our daily routines. And that's really the important part is, just to stay active. I always stress to our patients that they're going to run into respiratory therapists and nurses and physicians, but the patient is also part of that care team. So stay involved and stay active with their health. And that's probably one of the most important things, is to stay active.
Scott Webb: Yeah. Stay involved, stay active. There is no cure, but we can manage and treat. We want everyone to quit smoking and have a better quality of life. So thank you both for your time today. This was a really great conversation. A lot of great metaphors, analogies. I can really picture it all in my head. So thank you both and you both stay well.
Paul Bailey: Okay. Thank you very much.
Scott Webb: To schedule an appointment or learn more, call (330) 319-9700. And if you found this podcast helpful and informative, please share it on your social channels and be sure to check out the entire podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.