June 22, 2025 • 28 mins
06/22/25
The Healthy Matters Podcast
S04_E18 - The ABCs of COPD
With Special Guest: Dr. Caroline Davis, MD
Did you know that 6.5% of Americans have physician-diagnosed Chronic Obstructive Pulmonary Disease (COPD)? That's a pretty staggering statistic... You might think that people get it from smoking, and well, you'd be right. But that's not the only thing that can cause it! COPD is a disease of the airways where people have difficulty getting air out of there lungs. But why is that an issue? Who's most likely to be afflicted with this condition? And best yet, how can you avoid it altogether?
Joining us on Episode 18 of our show is Dr. Caroline Davis, a pulmonologist at Hennepin Healthcare, and just the expert to help us get to the bottom of some of these questions. We'll go over the common causes of COPD, who's at risk, the current and future treatments available, and how this condition differs from other afflictions, like emphysema and asthma. COPD can be a serious disease, but there are a lot great treatments available, and believe us when we say that at the end of this episode, you'll be breathing a little easier. Join us!
We're open to your comments or ideas for future shows!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Get a preview of upcoming shows on social media and find out more about our show at www.healthymatters.org.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 03 (00:01):
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 00 (00:18):
Hey, everybody, and welcome to episode 18 of the
podcast.
I am your host, Dr.
David Hilden, and today we'retackling a topic that doesn't
always make the headlines butaffects millions of people every
single day, that being chronicobstructive pulmonary disease,
or COPD.
Okay, if that sounds like amouthful, don't worry.
We're going to break it alldown.
Whether you've heard the termbefore or it's brand new
(00:40):
territory, by the end of thisepisode, you're going to be
breathing just a little biteasier knowing what it is, how
it shows up, who it affects, howit's treated, and most most
importantly, how you can helpprevent it.
To help make us a little wiseron the subject, I've got a
terrific guest joining me today,Dr.
Caroline Davis.
She is a pulmonologist who hasseen it all when it comes to
lung health.
Caroline, welcome to the show.
Speaker 02 (01:00):
Hi, thanks for having me.
Speaker 00 (01:01):
What's a pulmonologist?
I mean, I kind of know, I do,but could you help us out?
What exactly is apulmonologist?
Speaker 02 (01:06):
A pulmonologist is a lung doctor, someone that sees
people who have trouble withtheir breathing or trouble with
cough, issues with their lungs.
Speaker 00 (01:13):
And that's what you do?
That's what I do.
And you also do intensive care,right?
Speaker 02 (01:16):
I do, yes.
So I work in the intensive careunit where we care for people
that need life support.
Speaker 00 (01:21):
Is that always the case that the intensive care
doctors are also lung doctors?
Because most of them are here.
Speaker 02 (01:26):
Yeah, not always.
I think it's usually linkedtogether because of the need for
the breathing machine, theventilator, which is a form of
life support that we use all thetime in the ICU.
Speaker 00 (01:36):
Got it.
Okay, so we've got a lungdoctor here with us to talk
about lung disease.
Start with the basics, if youcould, in simple terms.
What is COPD?
Speaker 02 (01:44):
So COPD is a disease of the airways where people
develop difficulty getting allof the air out of their lungs.
And it's defined by,characterized by shortness of
breath that gets worse withexercise and gets worse over
time.
Speaker 00 (01:59):
That doesn't sound so scary.
They can't get the breath out.
Why is that a problem?
Speaker 02 (02:04):
Yeah, great question.
So if you can kind of imaginebreathing through a straw, at
first you might be able to kindof take big, deep breaths, but
eventually it takes so long toget the air out that you can't
get enough air in anymore.
and your lung volumes actuallygo down.
Speaker 00 (02:19):
So why does that happen?
Speaker 02 (02:20):
It happens because there's destruction of the
tissue that supports theairways, that keeps it open.
And so those airways, theycollapse when you're trying to
breathe out.
Speaker 00 (02:28):
So many people don't know that your lungs aren't
just big balloons, but there areall kinds of little tissue in
there and they've got all kindsof surface area in there.
They're not just open.
So in COPD, is it the lungtissue itself that's the problem
or is it the airways?
Speaker 02 (02:41):
So if you think about your lungs looking like an
upside down tree, Trachea, yourwindpipe, is like the trunk of
that tree, and then your airwaysbranch out as the branches of
the tree.
Now, on the ends of the treeare the leaves, but in your
lungs, there are these littlebubbles called alveoli, and they
help you absorb oxygen and getrid of carbon dioxide.
The disease COPD really affectsthe airways, the branches of
(03:04):
that tree, but it's oftenassociated with emphysema, which
is where there's destruction ofthe bubbles, the alveoli, and
so it can, in some ways, affectboth things.
Speaker 00 (03:13):
I think that's a term people maybe know,
emphysema.
So let's talk about the typesof COPD, emphysema being one of
them.
Could you say more about thatone?
What does it look like?
Why is it a problem?
And frankly, what causes it?
Speaker 02 (03:25):
Yeah, I think the way that the guidelines and I
think about COPD is that COPD isreally the trouble with getting
the air out.
And it is associated withemphysema, but you can have
emphysema without having COPD.
So emphysema is when there'sloss of some of those alveoli,
some of those bubbles, and theymake these basically larger
bubbles in your lungs.
And then you can't absorb asmuch oxygen.
(03:46):
You can't get rid of as muchcarbon dioxide.
Whereas COPD is really just theproblem with the airways
themselves.
Speaker 00 (03:51):
So you've got these in emphysema, you've got these
Bigger chunks of lung tissue,big holes in there.
I always think of it as likesomebody, a mouse, not somebody,
but a mouse or something chewedout the things and you've got
bigger holes, not just theselittle teeny small ones.
Speaker 02 (04:03):
Yes, that's what it looks like on a CT scan.
It kind of looks like cobwebs,like spider webs.
Speaker 00 (04:07):
Yeah, so what causes that?
Speaker 02 (04:09):
Yeah, so the most common cause of emphysema is by
and large going to be smoking.
And really it's a lifetime ofsmoking that usually causes it.
Speaker 00 (04:16):
So we got a lung doctor to say smoking's bad, but
it took you five minutes.
One of the things, this is alittle aside, but one of the
things on this podcast, we'vedone dozens, hundreds of
episodes, and smoking comes up alot.
And I guarantee you, listeners,smoking is going to be a
problem for many of the thingswe are talking about today.
So smoking causes emphysema.
(04:36):
Do we know why it does that?
Speaker 02 (04:38):
So smoking and really inhaling something that
is combusted into your lungscauses problems with the airways
because it destroys the part ofyour airways that helps get rid
of stuff like pus from aninfection.
It also just directs I think
Speaker 00 (05:00):
we can safely say don't put something that's on
fire into your mouth if you canhelp
Speaker 02 (05:05):
it.
100%.
Yeah,
Speaker 00 (05:06):
so that's our smoking public service
announcement for the day.
So that's emphysema.
Talk about some of the thingsthat can happen in COPD then
with the airways.
Speaker 02 (05:16):
So COPD, we usually kind of think about a few
different things that isassociated with COPD.
One is it causes breathlessnesswith activity.
It's often associated withchronic bronchitis, which is
where there's swelling and mucusproduction in the airways that
makes people cough and have aproductive cough, meaning
they're bringing stuff up whenthey cough.
People often experience chesttightness and chest congestion
(05:39):
along with these things.
Speaker 00 (05:40):
Are these also related to smoking or are there
some other causes for chronicinflammation in the airways?
Speaker 02 (05:46):
Well, I think usually COPD...
Chronic bronchitis, emphysemaare associated with smoking.
75% of the cases of COPD in theUnited States are caused by
smoking.
Other things that can causeCOPD are longstanding asthma,
exposure to biomass fuel, solike cooking with carbon-based
(06:06):
fuel sources, including likecoal or wood, can cause COPD.
There's also a number ofgenetic factors, and premature
birth can lead someone to getCOPD.
Speaker 00 (06:18):
I remember I did have an adult male patient who
had really bad emphysema and itwas from a genetic factor.
So it's not just smoking andall these other things.
There are some other causes ofthat.
You did mention asthma and I'mgoing to put a placeholder in
that because asthma is a form ofobstructive lung disease and
it's so common.
So I want to come back to thatand focus on asthma.
But before I do that, howcommon is COPD generally in the
(06:40):
country?
Speaker 02 (06:41):
Yeah, in the country, about 6.5% of people
have physician diagnosed COPD.
Speaker 00 (06:47):
That's a lot.
Speaker 02 (06:47):
That's a lot.
Yeah, it's very common.
Speaker 00 (06:49):
It's way more than I thought, actually.
Speaker 02 (06:50):
And in the world, it's 10%.
Is
Speaker 00 (06:51):
that because of biofuels and things in the
world, do you think, or moresmoking?
Speaker 02 (06:55):
Both.
Depends on the country.
So if you, like a low- andmiddle-income country where
people tend to use carbon-basedfuel sources, again, that's
wood, charcoal, for cooking,those countries have more
biomass fuel-related COPD.
Speaker 00 (07:10):
Is it more common at certain ages or other
demographics?
Speaker 02 (07:13):
Definitely.
It's way more common after theage of 50.
And it's much less common inyounger people.
Speaker 00 (07:19):
Yeah, I haven't seen too many younger folks, 20,
30-year-olds with COPD, exceptasthma.
We're going to come back toasthma.
Yeah, asthma's important.
Do you think it's on the rise?
Is it about the same?
Or what do you think in yourpractice?
Is it getting more and more ofit?
Or how are we doing?
Speaker 02 (07:33):
So in the United States from 2011 to 2021, the
percentage of people with COPDstayed the same, didn't change.
That being said, we've got acouple of factors that are
affecting how people arepresenting, which is that
smoking has gone down amongyoung people, 18 to 44.
So those, we see fewer patientslike that.
And we see more patients overthe age of 75 with COPD.
Speaker 00 (07:54):
Yeah.
And who knows what those 18 to44 year olds who aren't smoking
as much, but might be vaping andsome other things, who knows
what that's going to look like?
Speaker 02 (08:02):
Yes.
I mean, vaping has beenassociated with development of
COPD, but not to the same extentas cigarette smoking.
Speaker 00 (08:09):
Right.
Okay.
Let's talk about the individualwho has COPD.
What kind of symptoms do theyhave?
What does it look and feellike?
Speaker 02 (08:16):
People with COPD, experience shortness of breath,
especially with activity.
They also can experience chesttightness, chest congestion,
where they feel like there'sstuff in their chest that they
can't get up, sputum production,cough.
Speaker 00 (08:27):
That could be from a lot of things, doctor.
Speaker 02 (08:29):
It could indeed.
Yeah.
There's a lot of overlap withCOPD with other diseases, in
fact.
And many people with COPD havemore than one thing.
So it's important to getevaluated.
Speaker 00 (08:38):
How do you diagnose it then?
So somebody comes in, they'vegot that.
I'm having trouble breathing,doc.
What do I do?
Or what do you do?
Speaker 02 (08:43):
So I start with taking a really good history to
kind of understand when you youhave symptoms and if they come
and go or if they're constantand getting worse, I ask people
about everything they've inhaledbecause previous exposures to
things that you've inhaled cancause lung disease.
I also do an exam to look forwheezing or taking a long time
(09:04):
to exhale.
And then we do lung functiontesting where we test how big of
a breath you can take and howquickly you can get the air out.
And that's really veryimportant for the diagnosis of
COPD.
Speaker 00 (09:13):
You mentioned wheezing.
And for listeners out there,that's when your airways kind of
collapse.
And it's more of instead ofjust a nice, calm breath going
in and out, there's a littlehigh-pitched or low-pitched.
There's an extra sound on that.
What causes wheezing?
And does the patient knowthey're having wheezing?
Speaker 02 (09:28):
So the reason for the wheezing is it's really a
multi-tone sound.
We call it polyphonic soundthat we hear when someone is
exhaling when we listen with astethoscope.
Wheezing is caused by the smallairways, those small branches
on that tree that are narrowed.
And so you hear that kind ofwhistle sound with the air
(09:48):
moving through the airways onexhalation.
Speaker 00 (09:50):
Okay, everybody, you can say polyphonic.
Wheezing is a type ofpolyphonic sound.
Yep.
Speaker 02 (09:56):
Because you hear multiple tones.
So does the patient know thatthey're wheezing?
Sometimes they do, becausesometimes you can kind of feel
it, and sometimes you can hearkind of loud wheezing.
But most of the time, thepatient doesn't know that
they're wheezing, and we justhear it when we're listening
with the stethoscope.
When people can hear it, it'susually more affecting the large
airways.
Speaker 00 (10:16):
Do you have to do other diagnostic tests then
after you've visited with apatient, you've done all this
history, you've listened tothem?
Are there other diagnostictests you usually do?
Speaker 02 (10:24):
Yes.
So I think the other thingsthat are really important are
considering imaging, so x-raysor CTs, depending on the
patient, CAT scans, and thenblood tests to help figure out
what kind of inflammation theymay have in their blood.
Speaker 00 (10:37):
So earlier you mentioned asthma, and asthma is
huge.
And listeners, I would referyou back to an earlier episode
in a previous season with Dr.
Josh Dorn.
We talked a little bit aboutasthma, but I've never talked to
a lung doctor.
He was an allergist.
I've never talked to a lungdoctor about asthma.
Now that is something that kidshave and young adults have.
What is asthma?
Yeah, I
Speaker 02 (10:58):
think it becomes a little easier to understand if
we kind of compare it directlyto COPD.
So COPD is trouble getting allthe air out that gets worse
slowly over time.
It's progressive.
It's always there.
It gets worse.
Asthma causes variable troubleswith getting the air out.
Speaker 00 (11:13):
So you'll get kids, young adults, older adults with
asthma who will only get theirsymptoms at certain times
like...
before exercise or when it'sreally cold outside or when
their allergies act up, right?
Speaker 02 (11:24):
Exactly.
Asthma is a disease of bothinflammation and hyperreactivity
to something that's in theirenvironment, something that they
inhale.
Speaker 00 (11:30):
But they still have trouble getting air in and out,
right?
Speaker 02 (11:32):
They do.
And they really show the samethings on their lung function
testing, which is troublegetting all the air out.
The difference is that withasthma, we see an improvement
back to normal with inhalers,whereas with COPD, we don't see
an improvement back to normalwith
Speaker 00 (11:46):
inhalers.
So we're talking withpulmonologist Dr.
Caroline Davis all aboutchronic obstructive pulmonary
disease, or COPD.
When we come back from a shortbreak, we're going to talk about
what it's like to live with thecondition, available treatment
options, and how you can avoidCOPD altogether.
So stay tuned.
We'll be right back.
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(12:28):
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Speaker 00 (12:43):
And we're back talking about COPD with Dr.
Caroline Davis.
She is a lung doctor, otherwiseknown as a pulmonologist.
Caroline, can you tell uswhat's it like for a person to
live with COPD?
Speaker 02 (12:53):
I think it's a challenge.
You know, it's really hard tolive with breathlessness.
And some people with COPD, theyreally struggle to feel
confident going outside becausethey always have to plan for
when they have to take a breakbecause they're short of breath.
Speaker 00 (13:04):
So somebody who's got a significant COPD, a
symptomatic then, what doestheir daily life look like?
How do they get through theday?
Do they have to carry oxygentanks?
Do they take their inhalers?
What does it look like?
Speaker 02 (13:16):
Well, boy, it really depends on how bad the COPD is.
If it's mild, they might notreally notice that much impact
on their daily life.
Whereas if they have moderateor severe COPD, they might have
to plan to be able to have aplace to sit down when they're
feeling short of breath.
They might only be able to walkone block without having to
stop and rest.
Speaker 00 (13:33):
You mentioned something earlier that it It's a
little sobering if you thinkabout it that it's a progressive
disease.
Are there things people can doto slow down the progression?
Speaker 02 (13:42):
Yeah, great question.
So I think COPD I think aboutas a kind of premature aging.
Everyone's lung function kindof decreases with time.
All of ours does, right?
Everyone, yep.
You and me right now.
Yeah.
Lung
Speaker 00 (13:54):
function.
By the end of this podcast,we'll have lost a little.
No, seriously.
Seriously, Caroline.
Remember in med school when youwere first learning about flow
loops?
This is all lung function.
They draw these graphs and theyshow the decline of lung
function for everybody.
And it's like depressing as allheck because eventually- that
line hits the bottom and thenyou're kind of done.
Speaker 02 (14:15):
Well, if we all live to be 200, then yes.
Speaker 00 (14:17):
Yeah, exactly.
So this lung function declines,but in COPD, seriously, it does
decline faster and they show usthat line too.
It gets us a steeper line.
So what things can people do orare things people can do to
make it worse or make it better?
Speaker 02 (14:32):
Well, gosh, number one, two, and three is quitting
smoking or don't smoke.
Those are the most importantthings.
Speaker 00 (14:38):
It's never too late to do that.
You might not reverse thedamage that It's already been
done, but you can prevent itfrom getting worse.
Speaker 02 (14:45):
You can prevent it from getting worse.
And a lot of people with COPDwho are smokers have asthma
because they're inhalingsomething that their lungs don't
like every day, cigarettesmoke.
And so they might even feelbetter as far as their breathing
as soon as they quit smoking.
Speaker 00 (14:58):
Okay, so that is the first several bits of advice if
you happen to smoke.
What if you don't or you'reworking on that?
And folks, don't beat yourselfup for that.
It's hard to do.
You need to, you can, and youshould quit smoking.
Speaker 02 (15:10):
I'm obviously really passionate about this because
I'm a lung doctor, but quittingsmoking is super hard.
And most people, you know, theyhave to quit seven times before
they eventually are able tokind of kick the habit.
And so I really feel like usingtools to help you quit smoking
is really important.
And your doctor has a lot oftools to help you quit smoking.
And that includes nicotinereplacement, as well as
medications to help reducecravings.
(15:31):
And so thinking about using allthe tools in your toolbox to
help quit smoking is reallyimportant.
Speaker 00 (15:37):
What else can people do?
Speaker 02 (15:38):
So I think if you have asthma to get treatment for
your asthma, There's a lot oftreatments for asthma that can
really reduce the progressionand help you feel better and not
have flares.
Preventing respiratoryinfections, especially in
childhood, is an importantmethod to help prevent.
Speaker 00 (15:53):
Why especially in childhood?
Speaker 02 (15:54):
Your lungs are still developing.
Really, they're developing intoadulthood.
And so in order to kind ofprotect your lungs when they're
just developing, when they'restarting to kind of develop all
those little airways, it'sreally important to prevent bad
infections.
Speaker 00 (16:06):
Yeah, that makes sense.
That makes sense.
And as an older adult, get yourvaccines against pulmonary
infections, right?
Speaker 02 (16:11):
Oh, 100%.
Yeah, that's a huge factor indeath from COPD and in
preventing the progression is toget regular vaccinations for
respiratory diseases,especially.
Speaker 00 (16:22):
And there's lots of them, folks.
We've been talking about that,oh, for years and years.
But in the year 2020, we reallytalked about it.
And we're still talking aboutit today is get your vaccines is
still the best way to preventsome of those respiratory
infections.
Speaker 02 (16:34):
And the vaccines that we recommend are vaccines
against COVID-19, againstinfluenza.
Those are every year, as wellas vaccines for pneumonia Tdap,
which includes pertussis, whichis a respiratory infection.
Whooping cough, yeah.
Yeah, whooping cough, yep.
And RSV in people with COPD andasthma ages 60 and older.
Speaker 00 (16:51):
Okay, so that's really good advice.
Okay, so I'm doing all that.
I'm trying to quit smoking, orI have.
And I'm getting my asthma undercontrol.
I'm doing my best to keep mylungs healthy with my vaccines
and helping my kids stay healthywith lung diseases.
I'm doing all that.
Is there anything else I can doin my daily life?
Speaker 02 (17:08):
Yeah, I honestly think one of the most important
things to protect your wholebody especially when you have
lung disease or even if youdon't is regular physical
activity I can't make thenumbers on your lung function
better with COPD most of thetime.
But what I can do is helppeople feel better and help
people live longer by gettingregular activity.
Speaker 00 (17:27):
So let's talk about treatments and cures.
Is there a cure for COPD?
Speaker 02 (17:31):
There's not a cure, but there's lots of treatments
to help manage it.
There are two things that wereally aim for when we're trying
to treat COPD.
One of them is to reduceshortness of breath, and the
other thing is to reduce risks.
So to reduce shortness ofbreath, we think about inhalers
to help open up the airways.
We think about pulmonaryrehabilitation Which is a
program...
where people, it's both acombination of an educational
(17:54):
program and a monitored exerciseprogram so that you can work on
breathing techniques to helpwith breathing when you're
feeling short of breath and workon getting more physical
activity to help strengthen yourheart and your muscles so you
can go out and do more.
Speaker 00 (18:07):
Before you move on from pulmonary rehab, it's
something that when I have apatient who's done it, I'm
always glad they did it.
But I don't think enough peopleknow about it.
Where does one access apulmonary rehab
Speaker 02 (18:17):
program?
So there's a number ofpulmonary rehab programs at many
major hospitals.
And so I You can access it bytalking to your doctor about
pulmonary rehab.
And I bet anyone would bereally happy to refer you
because it's a great program,very low risk, and helps people
gain a lot of confidence.
Speaker 00 (18:31):
Yeah, it really is.
What about all these thingsthat people are inhaling and, I
might add, are endlesslyadvertised?
Speaker 02 (18:37):
Oh, yeah.
So there's a number ofdifferent inhalers.
I think the important thingwith COPD these days is that the
treatment is personalized.
And so how we treat it dependson you and your profile, and
that includes blood tests,imaging, and your symptoms.
So we use inhalers.
We use inhalers to help open upthe airways.
We use inhalers to help takedown inflammation, an inhaled
steroid.
And those are kind of the,these are the mainstay, the kind
(18:59):
of backbone of COPD treatment.
Speaker 00 (19:01):
Steroids, that's a word that sometimes freaks
people out.
So what does an inhaled steroid
Speaker 02 (19:05):
do?
Many people with COPD haveinflammation, swelling in their
airways that's going to causesome of that mucus production
and cause those airways to besmaller anyway.
And so the steroids help withthat inflammation.
They take it down.
But steroids are complicated inCOPD.
For some people, they makethings worse.
Because if they don't have alot of inflammation, then the
steroid in someone that has ahigher risk for infection can
(19:27):
actually increase your risk ofinfections.
And so it's really importantthat your doctor carefully
considers, is it time to do asteroid or is it not?
Speaker 00 (19:34):
Yeah, I think that's a really good point because
we've said that there's a couplethings that lead to COPD.
One of them is inflammation,but it's not the only thing.
Speaker 02 (19:42):
So the other thing that I want to say about inhaled
steroids is that the risk islower when you inhale a steroid
than when you take it by mouth.
However, the reason why weworry about it so much in COPD
is because the tissue of thelung is not working properly.
And so people with COPD aremore likely to get infections.
And so for them, using aninhaled steroid is more risky
than in using it with someonewith asthma,
Speaker 00 (20:05):
inflammation.
Okay.
What about then, as long aswe're on the topic of steroids,
there are steroids that come inpill form and other forms.
When do people need to takesomething like prednisone?
Speaker 02 (20:15):
So prednisone is a steroid pill that we use in
patients with COPD when theyhave a flare, an exacerbation.
An exacerbation is when someonehas kind of a quick...
increase in shortness ofbreath.
Sometimes they have more mucusproduction.
Sometimes their mucus changescolor.
And in those patients, theyneed a short course of
prednisone to help them get overtheir symptoms and feel better.
Speaker 00 (20:37):
Okay, so there are some inhalers, inhaled
corticosteroids, systemic orpill form steroids.
There's other meds in thoseinhalers too.
A lot of these inhalers havetwo or three things in them.
Without getting into the nittygritty details of those other
medications, how do thosecombination things work?
Speaker 02 (20:54):
Because COPD is primarily the problem is getting
the air out the mainstay oftreatment is really inhalers
that help open up the airwaysand there's an alphabet soup of
different inhalers but for mostpeople with COPD who have
symptoms we give them an inhalerthat's a combination of two
different medications that workall day and help to open up the
(21:15):
airways
Speaker 00 (21:16):
Okay, so Dr.
Davis, what else?
You've got inhalers.
We've talked about prednisone.
Speaker 02 (21:19):
So in people that have a lot of symptoms or have
frequent exacerbations wherethings get worse and they need
to take prednisone, we thinkabout more advanced therapies
depending on that patient andtheir profile.
So sometimes we think aboutusing injectable medications
just like we use for asthma andCOPD for people that have a lot
(21:39):
of inflammation.
Speaker 00 (21:41):
At this point, when people are needing these
medications, are they usuallyseeing you?
Are they seeing a pulmonologistby this point?
Speaker 02 (21:47):
Yes, 100%.
Because
Speaker 00 (21:48):
I haven't touched on that earlier.
Folks, you can go to yourprimary care physician or other
clinician when you're startingto have some symptoms.
But when we're starting to talkabout injectable medications
and some of the more challenginginhalers and the like, it's
time to see a pulmonologist.
Speaker 02 (22:02):
Yeah.
If you're on inhalers, thelong-acting inhalers, and you're
still having symptoms, andespecially if you're having
flares that are bringing youinto the hospital or bringing
you into the ER, that's when youshould see a pulmonologist.
Speaker 00 (22:13):
Yeah, I'm hoping that people get that message Go
see a lung specialist whenyou're getting into this stuff.
Speaker 02 (22:18):
Yeah, and I think so the injectable medications are
one thing we use.
We also sometimes, for somepeople, think about lung volume
reduction like a surgery.
Speaker 00 (22:27):
Lung volume reduction.
Okay, sign me up for that.
Why don't you take a chunk ofmy lung there, doctor?
Seriously?
Can you say some more aboutlung volume reduction?
You only have five lobes.
And I know I'm a generalinternal medicine doctor.
I'm not a lung doctor, but I amaware there are five lobes,
three in one lung and two in theother.
(22:47):
You take them out?
Speaker 02 (22:49):
Yes.
The idea behind this issometimes people have such
damaged lungs and it's often atthe top of their lungs that the
rest of their lung, the lungthat's mostly functional, can't
work at all and is totallysquished.
because the air in the topcan't get out.
And so sometimes we talk abouttaking out that piece of the
damaged lung in order for therest of the lung to re-expand
(23:10):
and be able to work better.
Speaker 00 (23:11):
That does make some sense, because as we talked
earlier in the show, this is aproblem of getting air out.
Emphysema is a problem ofdestruction of the alveoli into
bigger holes, and so air getstrapped in and lungs get big.
It just kind of does sound kindof funny.
So you've got a lung disease,so let's take part of it out.
Speaker 02 (23:28):
I know.
It's really weird.
I
Speaker 00 (23:29):
bet that's when it's getting pretty serious.
Speaker 02 (23:31):
That's when it's getting very serious.
Speaker 00 (23:32):
When do people need oxygen?
Speaker 02 (23:35):
Yeah, so people need oxygen when the oxygen levels
in their blood drop down below aspecific level.
And so it's not just forshortness of breath.
The oxygen doesn't necessarilyhelp with shortness of breath
unless the shortness of breathis from low oxygen.
You can be short of breath andhave totally normal oxygen
levels.
Speaker 00 (23:53):
That's kind of an interesting point.
So it literally is just usedwhen the oxygen levels are too
low to sustain you at a healthylevel.
Speaker 02 (24:01):
Exactly.
And some people need oxygenwhen they're having a flare in
the hospital and they don't needit when they go
Speaker 00 (24:05):
home.
Okay.
So you might need oxygen, butthat's sort of we're talking
about in a specific situation.
It's very much based on youroxygen levels, not for your
symptom control.
Is that correct?
Speaker 02 (24:14):
That's correct.
Speaker 00 (24:15):
Okay.
Terrific.
So people with lung disease andtrouble breathing often have a
complex collection of things.
They might have asthma.
They might have allergies.
They might be a smoker.
They might have emphysema.
All these things.
How do you sort all that outwhen someone comes in to see
you?
Speaker 02 (24:31):
This is why we have to collect a good history and
why we get testing to confirmthe diagnosis.
And so it's really important tosee your doctor if you're
having other symptoms.
There is a significant overlapwith asthma and COPD.
And therefore, there's also anoverlap with allergies because
allergies really overlap withasthma and allergies can cause
asthma.
And so getting an evaluation tosee if you have inflammation
(24:55):
from allergies and from asthmacan help determine if you might
benefit from certain medicationsthat we use to treat COPD and
prevent exacerbations.
The other things that peoplewith COPD tend to have,
especially in people that arecurrent or former smokers, is
heart disease.
And so it's really importantfor your doctor to kind of think
about, oh, are they symptomsfrom heart disease or are they
(25:17):
from COPD, and to do testing tomake sure that they know.
Speaker 00 (25:20):
Good tips, because not everything in the human body
is simple in just one littlething.
Sometimes you have to manage anumber of what we call
comorbidities.
That's the medical term for allof your medical problems.
Yeah.
Can I ask you to predict thefuture a little bit, or at least
when you are going to your lungconferences or talking with
other people in academicmedicine and pulmonology, what
(25:41):
is the future maybe looking likefor either therapies or
diagnoses for COPD?
Speaker 02 (25:45):
Well, I think we're really moving into an era of
personalized medicine.
And I've alluded to this acouple of times earlier in our
conversation, which is that weuse really advanced techniques
in getting laboratory data.
There are new techniques usingCT scans to help really see
exactly what's wrong with thelungs.
And I think we'll see more ofthat using this very specific
(26:06):
personalized data to guide howwe treat people to reduce risk.
The other thing that I seecoming down the pipeline is that
there's been a lot ofadvancements in how we treat
asthma.
Because asthma is a disease ofinflammation.
And I see that a lot of thosetreatments are also becoming
relevant to COPD or being testedfor patients with COPD to see
(26:26):
if it can help reduce flares andhelp people feel better.
Speaker 00 (26:30):
Before I let you go, I want to one more time talk
about prevention and stayinghealthy.
What advice would you give topeople?
I think I know what the mainone might be, but I want you to
say it again.
Unknown (26:43):
Okay.
Speaker 02 (26:43):
Yes, you know what the main one might be, which is
quit smoking or don't startsmoking.
I think the other things that Ithink are super important is,
again, treating asthma, gettingregular physical activity,
preventing infections.
And the other thing is you canprevent your children from
getting COPD if you get regularvaccinations and prenatal care
in pregnancy.
(27:03):
It's worth it to get evaluatedfor COPD because we can help you
feel better, we can reduceprogression of disease, and we
can help you live a moreindependent life.
And so I think that'simportant.
Dr.
Speaker 00 (27:14):
Caroline Davis is a pulmonologist at Hennepin
Healthcare in downtownMinneapolis.
And one of my colleagues here,thank you so much for being on
the show, Caroline.
Speaker 02 (27:21):
Oh, thank you for having me.
It's been great.
Speaker 00 (27:23):
Listeners, lots of good tips here for you.
And if you are having symptoms,please do seek out attention
with your clinician.
And I hope you'll join us forour next episode in two weeks'
time.
And in the meantime, be healthyand be well.
Speaker 03 (27:35):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(27:56):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers areJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult withyour physician if you have a
more serious or pressing healthconcern.
(28:18):
Until next time, be healthy andbe well.
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health, healthcare,
and what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 00 (00:18):
Hey, everybody, and welcome to episode 18 of the
podcast.
I am your host, Dr.
David Hilden, and today we'retackling a topic that doesn't
always make the headlines butaffects millions of people every
single day, that being chronicobstructive pulmonary disease,
or COPD.
Okay, if that sounds like amouthful, don't worry.
We're going to break it alldown.
Whether you've heard the termbefore or it's brand new
(00:40):
territory, by the end of thisepisode, you're going to be
breathing just a little biteasier knowing what it is, how
it shows up, who it affects, howit's treated, and most most
importantly, how you can helpprevent it.
To help make us a little wiseron the subject, I've got a
terrific guest joining me today,Dr.
Caroline Davis.
She is a pulmonologist who hasseen it all when it comes to
lung health.
Caroline, welcome to the show.
Speaker 02 (01:00):
Hi, thanks for having me.
Speaker 00 (01:01):
What's a pulmonologist?
I mean, I kind of know, I do,but could you help us out?
What exactly is apulmonologist?
Speaker 02 (01:06):
A pulmonologist is a lung doctor, someone that sees
people who have trouble withtheir breathing or trouble with
cough, issues with their lungs.
Speaker 00 (01:13):
And that's what you do?
That's what I do.
And you also do intensive care,right?
Speaker 02 (01:16):
I do, yes.
So I work in the intensive careunit where we care for people
that need life support.
Speaker 00 (01:21):
Is that always the case that the intensive care
doctors are also lung doctors?
Because most of them are here.
Speaker 02 (01:26):
Yeah, not always.
I think it's usually linkedtogether because of the need for
the breathing machine, theventilator, which is a form of
life support that we use all thetime in the ICU.
Speaker 00 (01:36):
Got it.
Okay, so we've got a lungdoctor here with us to talk
about lung disease.
Start with the basics, if youcould, in simple terms.
What is COPD?
Speaker 02 (01:44):
So COPD is a disease of the airways where people
develop difficulty getting allof the air out of their lungs.
And it's defined by,characterized by shortness of
breath that gets worse withexercise and gets worse over
time.
Speaker 00 (01:59):
That doesn't sound so scary.
They can't get the breath out.
Why is that a problem?
Speaker 02 (02:04):
Yeah, great question.
So if you can kind of imaginebreathing through a straw, at
first you might be able to kindof take big, deep breaths, but
eventually it takes so long toget the air out that you can't
get enough air in anymore.
and your lung volumes actuallygo down.
Speaker 00 (02:19):
So why does that happen?
Speaker 02 (02:20):
It happens because there's destruction of the
tissue that supports theairways, that keeps it open.
And so those airways, theycollapse when you're trying to
breathe out.
Speaker 00 (02:28):
So many people don't know that your lungs aren't
just big balloons, but there areall kinds of little tissue in
there and they've got all kindsof surface area in there.
They're not just open.
So in COPD, is it the lungtissue itself that's the problem
or is it the airways?
Speaker 02 (02:41):
So if you think about your lungs looking like an
upside down tree, Trachea, yourwindpipe, is like the trunk of
that tree, and then your airwaysbranch out as the branches of
the tree.
Now, on the ends of the treeare the leaves, but in your
lungs, there are these littlebubbles called alveoli, and they
help you absorb oxygen and getrid of carbon dioxide.
The disease COPD really affectsthe airways, the branches of
(03:04):
that tree, but it's oftenassociated with emphysema, which
is where there's destruction ofthe bubbles, the alveoli, and
so it can, in some ways, affectboth things.
Speaker 00 (03:13):
I think that's a term people maybe know,
emphysema.
So let's talk about the typesof COPD, emphysema being one of
them.
Could you say more about thatone?
What does it look like?
Why is it a problem?
And frankly, what causes it?
Speaker 02 (03:25):
Yeah, I think the way that the guidelines and I
think about COPD is that COPD isreally the trouble with getting
the air out.
And it is associated withemphysema, but you can have
emphysema without having COPD.
So emphysema is when there'sloss of some of those alveoli,
some of those bubbles, and theymake these basically larger
bubbles in your lungs.
And then you can't absorb asmuch oxygen.
(03:46):
You can't get rid of as muchcarbon dioxide.
Whereas COPD is really just theproblem with the airways
themselves.
Speaker 00 (03:51):
So you've got these in emphysema, you've got these
Bigger chunks of lung tissue,big holes in there.
I always think of it as likesomebody, a mouse, not somebody,
but a mouse or something chewedout the things and you've got
bigger holes, not just theselittle teeny small ones.
Speaker 02 (04:03):
Yes, that's what it looks like on a CT scan.
It kind of looks like cobwebs,like spider webs.
Speaker 00 (04:07):
Yeah, so what causes that?
Speaker 02 (04:09):
Yeah, so the most common cause of emphysema is by
and large going to be smoking.
And really it's a lifetime ofsmoking that usually causes it.
Speaker 00 (04:16):
So we got a lung doctor to say smoking's bad, but
it took you five minutes.
One of the things, this is alittle aside, but one of the
things on this podcast, we'vedone dozens, hundreds of
episodes, and smoking comes up alot.
And I guarantee you, listeners,smoking is going to be a
problem for many of the thingswe are talking about today.
So smoking causes emphysema.
(04:36):
Do we know why it does that?
Speaker 02 (04:38):
So smoking and really inhaling something that
is combusted into your lungscauses problems with the airways
because it destroys the part ofyour airways that helps get rid
of stuff like pus from aninfection.
It also just directs I think
Speaker 00 (05:00):
we can safely say don't put something that's on
fire into your mouth if you canhelp
Speaker 02 (05:05):
it.
100%.
Yeah,
Speaker 00 (05:06):
so that's our smoking public service
announcement for the day.
So that's emphysema.
Talk about some of the thingsthat can happen in COPD then
with the airways.
Speaker 02 (05:16):
So COPD, we usually kind of think about a few
different things that isassociated with COPD.
One is it causes breathlessnesswith activity.
It's often associated withchronic bronchitis, which is
where there's swelling and mucusproduction in the airways that
makes people cough and have aproductive cough, meaning
they're bringing stuff up whenthey cough.
People often experience chesttightness and chest congestion
(05:39):
along with these things.
Speaker 00 (05:40):
Are these also related to smoking or are there
some other causes for chronicinflammation in the airways?
Speaker 02 (05:46):
Well, I think usually COPD...
Chronic bronchitis, emphysemaare associated with smoking.
75% of the cases of COPD in theUnited States are caused by
smoking.
Other things that can causeCOPD are longstanding asthma,
exposure to biomass fuel, solike cooking with carbon-based
(06:06):
fuel sources, including likecoal or wood, can cause COPD.
There's also a number ofgenetic factors, and premature
birth can lead someone to getCOPD.
Speaker 00 (06:18):
I remember I did have an adult male patient who
had really bad emphysema and itwas from a genetic factor.
So it's not just smoking andall these other things.
There are some other causes ofthat.
You did mention asthma and I'mgoing to put a placeholder in
that because asthma is a form ofobstructive lung disease and
it's so common.
So I want to come back to thatand focus on asthma.
But before I do that, howcommon is COPD generally in the
(06:40):
country?
Speaker 02 (06:41):
Yeah, in the country, about 6.5% of people
have physician diagnosed COPD.
Speaker 00 (06:47):
That's a lot.
Speaker 02 (06:47):
That's a lot.
Yeah, it's very common.
Speaker 00 (06:49):
It's way more than I thought, actually.
Speaker 02 (06:50):
And in the world, it's 10%.
Is
Speaker 00 (06:51):
that because of biofuels and things in the
world, do you think, or moresmoking?
Speaker 02 (06:55):
Both.
Depends on the country.
So if you, like a low- andmiddle-income country where
people tend to use carbon-basedfuel sources, again, that's
wood, charcoal, for cooking,those countries have more
biomass fuel-related COPD.
Speaker 00 (07:10):
Is it more common at certain ages or other
demographics?
Speaker 02 (07:13):
Definitely.
It's way more common after theage of 50.
And it's much less common inyounger people.
Speaker 00 (07:19):
Yeah, I haven't seen too many younger folks, 20,
30-year-olds with COPD, exceptasthma.
We're going to come back toasthma.
Yeah, asthma's important.
Do you think it's on the rise?
Is it about the same?
Or what do you think in yourpractice?
Is it getting more and more ofit?
Or how are we doing?
Speaker 02 (07:33):
So in the United States from 2011 to 2021, the
percentage of people with COPDstayed the same, didn't change.
That being said, we've got acouple of factors that are
affecting how people arepresenting, which is that
smoking has gone down amongyoung people, 18 to 44.
So those, we see fewer patientslike that.
And we see more patients overthe age of 75 with COPD.
Speaker 00 (07:54):
Yeah.
And who knows what those 18 to44 year olds who aren't smoking
as much, but might be vaping andsome other things, who knows
what that's going to look like?
Speaker 02 (08:02):
Yes.
I mean, vaping has beenassociated with development of
COPD, but not to the same extentas cigarette smoking.
Speaker 00 (08:09):
Right.
Okay.
Let's talk about the individualwho has COPD.
What kind of symptoms do theyhave?
What does it look and feellike?
Speaker 02 (08:16):
People with COPD, experience shortness of breath,
especially with activity.
They also can experience chesttightness, chest congestion,
where they feel like there'sstuff in their chest that they
can't get up, sputum production,cough.
Speaker 00 (08:27):
That could be from a lot of things, doctor.
Speaker 02 (08:29):
It could indeed.
Yeah.
There's a lot of overlap withCOPD with other diseases, in
fact.
And many people with COPD havemore than one thing.
So it's important to getevaluated.
Speaker 00 (08:38):
How do you diagnose it then?
So somebody comes in, they'vegot that.
I'm having trouble breathing,doc.
What do I do?
Or what do you do?
Speaker 02 (08:43):
So I start with taking a really good history to
kind of understand when you youhave symptoms and if they come
and go or if they're constantand getting worse, I ask people
about everything they've inhaledbecause previous exposures to
things that you've inhaled cancause lung disease.
I also do an exam to look forwheezing or taking a long time
(09:04):
to exhale.
And then we do lung functiontesting where we test how big of
a breath you can take and howquickly you can get the air out.
And that's really veryimportant for the diagnosis of
COPD.
Speaker 00 (09:13):
You mentioned wheezing.
And for listeners out there,that's when your airways kind of
collapse.
And it's more of instead ofjust a nice, calm breath going
in and out, there's a littlehigh-pitched or low-pitched.
There's an extra sound on that.
What causes wheezing?
And does the patient knowthey're having wheezing?
Speaker 02 (09:28):
So the reason for the wheezing is it's really a
multi-tone sound.
We call it polyphonic soundthat we hear when someone is
exhaling when we listen with astethoscope.
Wheezing is caused by the smallairways, those small branches
on that tree that are narrowed.
And so you hear that kind ofwhistle sound with the air
(09:48):
moving through the airways onexhalation.
Speaker 00 (09:50):
Okay, everybody, you can say polyphonic.
Wheezing is a type ofpolyphonic sound.
Yep.
Speaker 02 (09:56):
Because you hear multiple tones.
So does the patient know thatthey're wheezing?
Sometimes they do, becausesometimes you can kind of feel
it, and sometimes you can hearkind of loud wheezing.
But most of the time, thepatient doesn't know that
they're wheezing, and we justhear it when we're listening
with the stethoscope.
When people can hear it, it'susually more affecting the large
airways.
Speaker 00 (10:16):
Do you have to do other diagnostic tests then
after you've visited with apatient, you've done all this
history, you've listened tothem?
Are there other diagnostictests you usually do?
Speaker 02 (10:24):
Yes.
So I think the other thingsthat are really important are
considering imaging, so x-raysor CTs, depending on the
patient, CAT scans, and thenblood tests to help figure out
what kind of inflammation theymay have in their blood.
Speaker 00 (10:37):
So earlier you mentioned asthma, and asthma is
huge.
And listeners, I would referyou back to an earlier episode
in a previous season with Dr.
Josh Dorn.
We talked a little bit aboutasthma, but I've never talked to
a lung doctor.
He was an allergist.
I've never talked to a lungdoctor about asthma.
Now that is something that kidshave and young adults have.
What is asthma?
Yeah, I
Speaker 02 (10:58):
think it becomes a little easier to understand if
we kind of compare it directlyto COPD.
So COPD is trouble getting allthe air out that gets worse
slowly over time.
It's progressive.
It's always there.
It gets worse.
Asthma causes variable troubleswith getting the air out.
Speaker 00 (11:13):
So you'll get kids, young adults, older adults with
asthma who will only get theirsymptoms at certain times
like...
before exercise or when it'sreally cold outside or when
their allergies act up, right?
Speaker 02 (11:24):
Exactly.
Asthma is a disease of bothinflammation and hyperreactivity
to something that's in theirenvironment, something that they
inhale.
Speaker 00 (11:30):
But they still have trouble getting air in and out,
right?
Speaker 02 (11:32):
They do.
And they really show the samethings on their lung function
testing, which is troublegetting all the air out.
The difference is that withasthma, we see an improvement
back to normal with inhalers,whereas with COPD, we don't see
an improvement back to normalwith
Speaker 00 (11:46):
inhalers.
So we're talking withpulmonologist Dr.
Caroline Davis all aboutchronic obstructive pulmonary
disease, or COPD.
When we come back from a shortbreak, we're going to talk about
what it's like to live with thecondition, available treatment
options, and how you can avoidCOPD altogether.
So stay tuned.
We'll be right back.
Speaker 01 (12:06):
When Hennepin Healthcare says, we're here for
life, they mean here for you,your life, and all that it
brings.
Hennepin Healthcare has ahospital, HCMC, a network of
clinics in the metro area, andan integrative health clinic in
downtown Minneapolis.
They provide all of the primaryand specialty care you'd expect
to find, as well as serviceslike acupuncture and
(12:28):
chiropractic care.
Learn more athennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 00 (12:43):
And we're back talking about COPD with Dr.
Caroline Davis.
She is a lung doctor, otherwiseknown as a pulmonologist.
Caroline, can you tell uswhat's it like for a person to
live with COPD?
Speaker 02 (12:53):
I think it's a challenge.
You know, it's really hard tolive with breathlessness.
And some people with COPD, theyreally struggle to feel
confident going outside becausethey always have to plan for
when they have to take a breakbecause they're short of breath.
Speaker 00 (13:04):
So somebody who's got a significant COPD, a
symptomatic then, what doestheir daily life look like?
How do they get through theday?
Do they have to carry oxygentanks?
Do they take their inhalers?
What does it look like?
Speaker 02 (13:16):
Well, boy, it really depends on how bad the COPD is.
If it's mild, they might notreally notice that much impact
on their daily life.
Whereas if they have moderateor severe COPD, they might have
to plan to be able to have aplace to sit down when they're
feeling short of breath.
They might only be able to walkone block without having to
stop and rest.
Speaker 00 (13:33):
You mentioned something earlier that it It's a
little sobering if you thinkabout it that it's a progressive
disease.
Are there things people can doto slow down the progression?
Speaker 02 (13:42):
Yeah, great question.
So I think COPD I think aboutas a kind of premature aging.
Everyone's lung function kindof decreases with time.
All of ours does, right?
Everyone, yep.
You and me right now.
Yeah.
Lung
Speaker 00 (13:54):
function.
By the end of this podcast,we'll have lost a little.
No, seriously.
Seriously, Caroline.
Remember in med school when youwere first learning about flow
loops?
This is all lung function.
They draw these graphs and theyshow the decline of lung
function for everybody.
And it's like depressing as allheck because eventually- that
line hits the bottom and thenyou're kind of done.
Speaker 02 (14:15):
Well, if we all live to be 200, then yes.
Speaker 00 (14:17):
Yeah, exactly.
So this lung function declines,but in COPD, seriously, it does
decline faster and they show usthat line too.
It gets us a steeper line.
So what things can people do orare things people can do to
make it worse or make it better?
Speaker 02 (14:32):
Well, gosh, number one, two, and three is quitting
smoking or don't smoke.
Those are the most importantthings.
Speaker 00 (14:38):
It's never too late to do that.
You might not reverse thedamage that It's already been
done, but you can prevent itfrom getting worse.
Speaker 02 (14:45):
You can prevent it from getting worse.
And a lot of people with COPDwho are smokers have asthma
because they're inhalingsomething that their lungs don't
like every day, cigarettesmoke.
And so they might even feelbetter as far as their breathing
as soon as they quit smoking.
Speaker 00 (14:58):
Okay, so that is the first several bits of advice if
you happen to smoke.
What if you don't or you'reworking on that?
And folks, don't beat yourselfup for that.
It's hard to do.
You need to, you can, and youshould quit smoking.
Speaker 02 (15:10):
I'm obviously really passionate about this because
I'm a lung doctor, but quittingsmoking is super hard.
And most people, you know, theyhave to quit seven times before
they eventually are able tokind of kick the habit.
And so I really feel like usingtools to help you quit smoking
is really important.
And your doctor has a lot oftools to help you quit smoking.
And that includes nicotinereplacement, as well as
medications to help reducecravings.
(15:31):
And so thinking about using allthe tools in your toolbox to
help quit smoking is reallyimportant.
Speaker 00 (15:37):
What else can people do?
Speaker 02 (15:38):
So I think if you have asthma to get treatment for
your asthma, There's a lot oftreatments for asthma that can
really reduce the progressionand help you feel better and not
have flares.
Preventing respiratoryinfections, especially in
childhood, is an importantmethod to help prevent.
Speaker 00 (15:53):
Why especially in childhood?
Speaker 02 (15:54):
Your lungs are still developing.
Really, they're developing intoadulthood.
And so in order to kind ofprotect your lungs when they're
just developing, when they'restarting to kind of develop all
those little airways, it'sreally important to prevent bad
infections.
Speaker 00 (16:06):
Yeah, that makes sense.
That makes sense.
And as an older adult, get yourvaccines against pulmonary
infections, right?
Speaker 02 (16:11):
Oh, 100%.
Yeah, that's a huge factor indeath from COPD and in
preventing the progression is toget regular vaccinations for
respiratory diseases,especially.
Speaker 00 (16:22):
And there's lots of them, folks.
We've been talking about that,oh, for years and years.
But in the year 2020, we reallytalked about it.
And we're still talking aboutit today is get your vaccines is
still the best way to preventsome of those respiratory
infections.
Speaker 02 (16:34):
And the vaccines that we recommend are vaccines
against COVID-19, againstinfluenza.
Those are every year, as wellas vaccines for pneumonia Tdap,
which includes pertussis, whichis a respiratory infection.
Whooping cough, yeah.
Yeah, whooping cough, yep.
And RSV in people with COPD andasthma ages 60 and older.
Speaker 00 (16:51):
Okay, so that's really good advice.
Okay, so I'm doing all that.
I'm trying to quit smoking, orI have.
And I'm getting my asthma undercontrol.
I'm doing my best to keep mylungs healthy with my vaccines
and helping my kids stay healthywith lung diseases.
I'm doing all that.
Is there anything else I can doin my daily life?
Speaker 02 (17:08):
Yeah, I honestly think one of the most important
things to protect your wholebody especially when you have
lung disease or even if youdon't is regular physical
activity I can't make thenumbers on your lung function
better with COPD most of thetime.
But what I can do is helppeople feel better and help
people live longer by gettingregular activity.
Speaker 00 (17:27):
So let's talk about treatments and cures.
Is there a cure for COPD?
Speaker 02 (17:31):
There's not a cure, but there's lots of treatments
to help manage it.
There are two things that wereally aim for when we're trying
to treat COPD.
One of them is to reduceshortness of breath, and the
other thing is to reduce risks.
So to reduce shortness ofbreath, we think about inhalers
to help open up the airways.
We think about pulmonaryrehabilitation Which is a
program...
where people, it's both acombination of an educational
(17:54):
program and a monitored exerciseprogram so that you can work on
breathing techniques to helpwith breathing when you're
feeling short of breath and workon getting more physical
activity to help strengthen yourheart and your muscles so you
can go out and do more.
Speaker 00 (18:07):
Before you move on from pulmonary rehab, it's
something that when I have apatient who's done it, I'm
always glad they did it.
But I don't think enough peopleknow about it.
Where does one access apulmonary rehab
Speaker 02 (18:17):
program?
So there's a number ofpulmonary rehab programs at many
major hospitals.
And so I You can access it bytalking to your doctor about
pulmonary rehab.
And I bet anyone would bereally happy to refer you
because it's a great program,very low risk, and helps people
gain a lot of confidence.
Speaker 00 (18:31):
Yeah, it really is.
What about all these thingsthat people are inhaling and, I
might add, are endlesslyadvertised?
Speaker 02 (18:37):
Oh, yeah.
So there's a number ofdifferent inhalers.
I think the important thingwith COPD these days is that the
treatment is personalized.
And so how we treat it dependson you and your profile, and
that includes blood tests,imaging, and your symptoms.
So we use inhalers.
We use inhalers to help open upthe airways.
We use inhalers to help takedown inflammation, an inhaled
steroid.
And those are kind of the,these are the mainstay, the kind
(18:59):
of backbone of COPD treatment.
Speaker 00 (19:01):
Steroids, that's a word that sometimes freaks
people out.
So what does an inhaled steroid
Speaker 02 (19:05):
do?
Many people with COPD haveinflammation, swelling in their
airways that's going to causesome of that mucus production
and cause those airways to besmaller anyway.
And so the steroids help withthat inflammation.
They take it down.
But steroids are complicated inCOPD.
For some people, they makethings worse.
Because if they don't have alot of inflammation, then the
steroid in someone that has ahigher risk for infection can
(19:27):
actually increase your risk ofinfections.
And so it's really importantthat your doctor carefully
considers, is it time to do asteroid or is it not?
Speaker 00 (19:34):
Yeah, I think that's a really good point because
we've said that there's a couplethings that lead to COPD.
One of them is inflammation,but it's not the only thing.
Speaker 02 (19:42):
So the other thing that I want to say about inhaled
steroids is that the risk islower when you inhale a steroid
than when you take it by mouth.
However, the reason why weworry about it so much in COPD
is because the tissue of thelung is not working properly.
And so people with COPD aremore likely to get infections.
And so for them, using aninhaled steroid is more risky
than in using it with someonewith asthma,
Speaker 00 (20:05):
inflammation.
Okay.
What about then, as long aswe're on the topic of steroids,
there are steroids that come inpill form and other forms.
When do people need to takesomething like prednisone?
Speaker 02 (20:15):
So prednisone is a steroid pill that we use in
patients with COPD when theyhave a flare, an exacerbation.
An exacerbation is when someonehas kind of a quick...
increase in shortness ofbreath.
Sometimes they have more mucusproduction.
Sometimes their mucus changescolor.
And in those patients, theyneed a short course of
prednisone to help them get overtheir symptoms and feel better.
Speaker 00 (20:37):
Okay, so there are some inhalers, inhaled
corticosteroids, systemic orpill form steroids.
There's other meds in thoseinhalers too.
A lot of these inhalers havetwo or three things in them.
Without getting into the nittygritty details of those other
medications, how do thosecombination things work?
Speaker 02 (20:54):
Because COPD is primarily the problem is getting
the air out the mainstay oftreatment is really inhalers
that help open up the airwaysand there's an alphabet soup of
different inhalers but for mostpeople with COPD who have
symptoms we give them an inhalerthat's a combination of two
different medications that workall day and help to open up the
(21:15):
airways
Speaker 00 (21:16):
Okay, so Dr.
Davis, what else?
You've got inhalers.
We've talked about prednisone.
Speaker 02 (21:19):
So in people that have a lot of symptoms or have
frequent exacerbations wherethings get worse and they need
to take prednisone, we thinkabout more advanced therapies
depending on that patient andtheir profile.
So sometimes we think aboutusing injectable medications
just like we use for asthma andCOPD for people that have a lot
(21:39):
of inflammation.
Speaker 00 (21:41):
At this point, when people are needing these
medications, are they usuallyseeing you?
Are they seeing a pulmonologistby this point?
Speaker 02 (21:47):
Yes, 100%.
Because
Speaker 00 (21:48):
I haven't touched on that earlier.
Folks, you can go to yourprimary care physician or other
clinician when you're startingto have some symptoms.
But when we're starting to talkabout injectable medications
and some of the more challenginginhalers and the like, it's
time to see a pulmonologist.
Speaker 02 (22:02):
Yeah.
If you're on inhalers, thelong-acting inhalers, and you're
still having symptoms, andespecially if you're having
flares that are bringing youinto the hospital or bringing
you into the ER, that's when youshould see a pulmonologist.
Speaker 00 (22:13):
Yeah, I'm hoping that people get that message Go
see a lung specialist whenyou're getting into this stuff.
Speaker 02 (22:18):
Yeah, and I think so the injectable medications are
one thing we use.
We also sometimes, for somepeople, think about lung volume
reduction like a surgery.
Speaker 00 (22:27):
Lung volume reduction.
Okay, sign me up for that.
Why don't you take a chunk ofmy lung there, doctor?
Seriously?
Can you say some more aboutlung volume reduction?
You only have five lobes.
And I know I'm a generalinternal medicine doctor.
I'm not a lung doctor, but I amaware there are five lobes,
three in one lung and two in theother.
(22:47):
You take them out?
Speaker 02 (22:49):
Yes.
The idea behind this issometimes people have such
damaged lungs and it's often atthe top of their lungs that the
rest of their lung, the lungthat's mostly functional, can't
work at all and is totallysquished.
because the air in the topcan't get out.
And so sometimes we talk abouttaking out that piece of the
damaged lung in order for therest of the lung to re-expand
(23:10):
and be able to work better.
Speaker 00 (23:11):
That does make some sense, because as we talked
earlier in the show, this is aproblem of getting air out.
Emphysema is a problem ofdestruction of the alveoli into
bigger holes, and so air getstrapped in and lungs get big.
It just kind of does sound kindof funny.
So you've got a lung disease,so let's take part of it out.
Speaker 02 (23:28):
I know.
It's really weird.
I
Speaker 00 (23:29):
bet that's when it's getting pretty serious.
Speaker 02 (23:31):
That's when it's getting very serious.
Speaker 00 (23:32):
When do people need oxygen?
Speaker 02 (23:35):
Yeah, so people need oxygen when the oxygen levels
in their blood drop down below aspecific level.
And so it's not just forshortness of breath.
The oxygen doesn't necessarilyhelp with shortness of breath
unless the shortness of breathis from low oxygen.
You can be short of breath andhave totally normal oxygen
levels.
Speaker 00 (23:53):
That's kind of an interesting point.
So it literally is just usedwhen the oxygen levels are too
low to sustain you at a healthylevel.
Speaker 02 (24:01):
Exactly.
And some people need oxygenwhen they're having a flare in
the hospital and they don't needit when they go
Speaker 00 (24:05):
home.
Okay.
So you might need oxygen, butthat's sort of we're talking
about in a specific situation.
It's very much based on youroxygen levels, not for your
symptom control.
Is that correct?
Speaker 02 (24:14):
That's correct.
Speaker 00 (24:15):
Okay.
Terrific.
So people with lung disease andtrouble breathing often have a
complex collection of things.
They might have asthma.
They might have allergies.
They might be a smoker.
They might have emphysema.
All these things.
How do you sort all that outwhen someone comes in to see
you?
Speaker 02 (24:31):
This is why we have to collect a good history and
why we get testing to confirmthe diagnosis.
And so it's really important tosee your doctor if you're
having other symptoms.
There is a significant overlapwith asthma and COPD.
And therefore, there's also anoverlap with allergies because
allergies really overlap withasthma and allergies can cause
asthma.
And so getting an evaluation tosee if you have inflammation
(24:55):
from allergies and from asthmacan help determine if you might
benefit from certain medicationsthat we use to treat COPD and
prevent exacerbations.
The other things that peoplewith COPD tend to have,
especially in people that arecurrent or former smokers, is
heart disease.
And so it's really importantfor your doctor to kind of think
about, oh, are they symptomsfrom heart disease or are they
(25:17):
from COPD, and to do testing tomake sure that they know.
Speaker 00 (25:20):
Good tips, because not everything in the human body
is simple in just one littlething.
Sometimes you have to manage anumber of what we call
comorbidities.
That's the medical term for allof your medical problems.
Yeah.
Can I ask you to predict thefuture a little bit, or at least
when you are going to your lungconferences or talking with
other people in academicmedicine and pulmonology, what
(25:41):
is the future maybe looking likefor either therapies or
diagnoses for COPD?
Speaker 02 (25:45):
Well, I think we're really moving into an era of
personalized medicine.
And I've alluded to this acouple of times earlier in our
conversation, which is that weuse really advanced techniques
in getting laboratory data.
There are new techniques usingCT scans to help really see
exactly what's wrong with thelungs.
And I think we'll see more ofthat using this very specific
(26:06):
personalized data to guide howwe treat people to reduce risk.
The other thing that I seecoming down the pipeline is that
there's been a lot ofadvancements in how we treat
asthma.
Because asthma is a disease ofinflammation.
And I see that a lot of thosetreatments are also becoming
relevant to COPD or being testedfor patients with COPD to see
(26:26):
if it can help reduce flares andhelp people feel better.
Speaker 00 (26:30):
Before I let you go, I want to one more time talk
about prevention and stayinghealthy.
What advice would you give topeople?
I think I know what the mainone might be, but I want you to
say it again.
Unknown (26:43):
Okay.
Speaker 02 (26:43):
Yes, you know what the main one might be, which is
quit smoking or don't startsmoking.
I think the other things that Ithink are super important is,
again, treating asthma, gettingregular physical activity,
preventing infections.
And the other thing is you canprevent your children from
getting COPD if you get regularvaccinations and prenatal care
in pregnancy.
(27:03):
It's worth it to get evaluatedfor COPD because we can help you
feel better, we can reduceprogression of disease, and we
can help you live a moreindependent life.
And so I think that'simportant.
Dr.
Speaker 00 (27:14):
Caroline Davis is a pulmonologist at Hennepin
Healthcare in downtownMinneapolis.
And one of my colleagues here,thank you so much for being on
the show, Caroline.
Speaker 02 (27:21):
Oh, thank you for having me.
It's been great.
Speaker 00 (27:23):
Listeners, lots of good tips here for you.
And if you are having symptoms,please do seek out attention
with your clinician.
And I hope you'll join us forour next episode in two weeks'
time.
And in the meantime, be healthyand be well.
Speaker 03 (27:35):
Thanks for listening to the Healthy Matters Podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters Podcast or
browse the archive, visithealthymatters.org.
Got a question or a comment forthe show?
Email us at healthymatters athcmed.org or call 612-873-TALK.
There's also a link in the shownotes.
(27:56):
The Healthy Matters podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas atHighball.
Executive producers areJonathan Comito and Christine
Hill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
We urge you to consult withyour physician if you have a
more serious or pressing healthconcern.
(28:18):
Until next time, be healthy andbe well.
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