According to the COPD Foundation, COPD affects an estimated 30 million individuals in the U.S., and over half of them have symptoms of COPD and do not know it. Early screening can identify COPD before major loss of lung function occurs.
Listen today as David M. Warren, the Director of Cardiopulmonary Services Aspirus Medford Hospital and Clinics, discusses COPD and ways to prevent it.
Selected Podcast
Do You Suffer From COPD?
Featured Speaker:
David Warren, BS
David Warren, BS, RRT, is the Director of Cardiopulmonary Services at Aspirus Medford Hospital and Clinics. Transcription:
Do You Suffer From COPD?
Melanie Cole (Host): According to the COPD foundation, COPD affects an estimated 30 million individuals in the United States and over half of them have symptoms of COPD and do not know it. My guest today is David Warren. He’s the Director of Cardiopulmonary Services at Aspirus Medford Hospital and Clinics. Welcome to the show, David. So, what is COPD?
David Warren (Guest): Well, COPD is a category of diseases. It encompasses emphysema and chronic bronchitis primarily. In its evolution, actually, of trying to determine – trying to categorize these lung diseases into different categories -- it is probably the most well known out there to the public due to media coverage, and they had a lot of advertising done by pharmaceutical companies too.
Melanie: Is there an early screening that can identify COPD before major loss of lung function occurs?
David: Yes, one of the biggest things that is contributing to COPD, unfortunately, is still the continued effort of people that do smoke. It’s usually long-term effects of chronic tobacco abuse, but other things can come into factor too. The type of employment that you have, for instance, working on a farm, working with chemicals, and things like that, where you’re being exposed to – if you don’t have the proper protective equipment to protect yourself, but primarily it is from tobacco itself. A lot of patients that we see typically don’t have issues until they get into even as early as their 40s, but in their 50s and 60s where they notice that they’ll slowly decline in their ability to catch their breath. They typically will complain about a chronic, productive cough, and that’s unfortunately when they do seek out treatment is when they’ve already started further into the disease process.
Melanie: What about screening? How do we know?
David: The screening typically that we do here is someone comes and sees their provider, and they’re complaining about shortness of breath, or having a chronic cough, and they will order what’s called a pulmonary function test. That test basically tells us a norm of comparison to a person’s height, their sex, whether they’re male or female, their ethnicity, and also their age. Basically, from that, it tells us what would be normal ranges for what they should be doing as far as the speed of the air that they’re moving, and also the capacity, or the volume of air that they’re moving.
Melanie: So once somebody has COPD or pre-COPD, and they’ve damaged their lungs, can that be repaired because we learn about heart disease being able to reverse to a degree, and diabetes is the same, but what about lung function and lung damage?
David: Unfortunately there is not as much of return on that. In fact, once the damage is done, there really isn’t much further that we can do at this point that’s been proven to improve lung function. However, what we can do, is – especially if they’re in the early stages of having the disease process is A- get an intervention done if they are continuing smoking, to stop -- getting help to be able to do that. We’ve changed our mindset over the years of how we treat tobacco dependence, and I say that in that it is an addiction to nicotine. Recently, in the last ten years, we’ve changed our mindset provider-wise and healthcare professionals to treat it more as an addiction versus actually just a bad habit.
Melanie: So then what are some of the treatments that are available and if exercise becomes a limiting factor and V-O-2, that amount of oxygen that’s consumed is tough to get, then exercise can sometimes be difficult for the person when that’s what they want to do as well.
David: Right. What we do have offered here at Aspirus is we do have free smoking cessation offered to any, and all patients here. That’s been a gradual build-up of exposure, trying to get patients who are interested in quitting smoking and giving them some tools and resources to try to be successful at that. But also, the other thing is once they are diagnosed with COPD, through true pulmonary function testing is we try to get them into what’s called a pulmonary rehab program. That’s where we try to reteach them not only habits of how they manage their breathing, but also, okay, let’s build up your exercise tolerance by having you learn different techniques for how you breathe. We reteach how they breathe and that helps them manage their symptoms better. The biggest thing is anxiety. I think that’s probably another factor that we have to keep in that concept of trying to do the overall treatment for these folks
Melanie: So David, let’s talk about teaching people to rebreathe because we’ve all heard about diaphragm breathing, but in pulmonary rehab, you teach a Valsalva, a way of holding your breath and releasing that air in tiny amounts. Speak about how that can increase that oxygen saturation and help people to get that breath that they’re missing.
David: Sure. Typically, what people want to do is they want to open their mouth wide when they’re having shortness of breath. What we try to do is reteach what’s called pursed-lip breathing. That pursed-lip breathing technique is basically almost like you’re trying to blow out a candle – think of – with really tight lips, or maybe – not that I play trumpet, but Imagine the same type of almost technique they would use for playing that type of instrument. What that does is – with COPD, what happens is the airways want to collapse down when they exhale out. By having that breathing technique of having them breathe in through the nose and pursed-lip out through the mouth, it actually helps splint the airways open and that way the airways aren’t feeling like they want to collapse down. We actually try to keep some back pressure – as layman’s terms –to keep those airways open as long as they can so they don’t collapse down.
Melanie: And what about when somebody does have to go on oxygen, what advice do you have for people that might have severe COPD -- and advanced -- and have to use oxygen.
David: Well, let’s face it, no one wants to have oxygen if they don’t have to, but once we’re able to do some education on the benefits of having oxygen, that helps a lot. It’s really a lot of discussion on the fears of that. One big thing is open flames or flammable material nearby. Oxygen isn’t combustible, but it helps support combustion. It’s not like gas where it would make a fire roar, but it will certainly add to a fire and be more enhanced because it is 100% oxygen. It’s more of teaching them the safety things. We still have people who are smoking up to this point so we try to really indicate you can’t have open flames, smoking a cigarette, or something like that. Also, looking at their activities of daily life, there's different sized tanks in that it can make them smaller, more manageable to carry around as well as portable, what are called concentrators. That’s a machine that actually takes air that we breathe out of air and concentrates the oxygen and delivers that through electronic machines
Melanie: So give your best advice, David, for staying healthy, avoiding exacerbations of their COPD and breathing problems and even avoiding things like pneumonia, which can really make this worse.
David: Yes, well the CDC certainly recommends obviously – especially those that have already the diagnosis of COPD to make sure that they do get a flu shot and that they do have a pneumonia shot during the indicated times. Those are probably some of the biggest things they can do preventative-wise. The other thing too is masking when you are having a cold, or if you are going to a clinic, we always ask folks to be aware of that, good hand hygiene, taking our medications as indicated. And then if we are having signs and symptoms that they're not feeling better, that they get in to see their provider right away. Our biggest challenge that we’re going to have is trying to reach those folks that are in that stage of they haven’t really gotten into the levels that they’re feeling really short of breath yet, but they probably are having a chronic cough, and that is really where we need to try to focus our attention to is to get those folks quitting smoking earlier so that they have a better chance of not going down that road.
Melanie: Really great information, David, thanks so much for being with us today. You’re listening to Aspirus Healthtalk, and for more information, you can go to Aspirus.org, that’s Aspirus.org. This is Melanie Cole. Thanks, so much, for listening.
Do You Suffer From COPD?
Melanie Cole (Host): According to the COPD foundation, COPD affects an estimated 30 million individuals in the United States and over half of them have symptoms of COPD and do not know it. My guest today is David Warren. He’s the Director of Cardiopulmonary Services at Aspirus Medford Hospital and Clinics. Welcome to the show, David. So, what is COPD?
David Warren (Guest): Well, COPD is a category of diseases. It encompasses emphysema and chronic bronchitis primarily. In its evolution, actually, of trying to determine – trying to categorize these lung diseases into different categories -- it is probably the most well known out there to the public due to media coverage, and they had a lot of advertising done by pharmaceutical companies too.
Melanie: Is there an early screening that can identify COPD before major loss of lung function occurs?
David: Yes, one of the biggest things that is contributing to COPD, unfortunately, is still the continued effort of people that do smoke. It’s usually long-term effects of chronic tobacco abuse, but other things can come into factor too. The type of employment that you have, for instance, working on a farm, working with chemicals, and things like that, where you’re being exposed to – if you don’t have the proper protective equipment to protect yourself, but primarily it is from tobacco itself. A lot of patients that we see typically don’t have issues until they get into even as early as their 40s, but in their 50s and 60s where they notice that they’ll slowly decline in their ability to catch their breath. They typically will complain about a chronic, productive cough, and that’s unfortunately when they do seek out treatment is when they’ve already started further into the disease process.
Melanie: What about screening? How do we know?
David: The screening typically that we do here is someone comes and sees their provider, and they’re complaining about shortness of breath, or having a chronic cough, and they will order what’s called a pulmonary function test. That test basically tells us a norm of comparison to a person’s height, their sex, whether they’re male or female, their ethnicity, and also their age. Basically, from that, it tells us what would be normal ranges for what they should be doing as far as the speed of the air that they’re moving, and also the capacity, or the volume of air that they’re moving.
Melanie: So once somebody has COPD or pre-COPD, and they’ve damaged their lungs, can that be repaired because we learn about heart disease being able to reverse to a degree, and diabetes is the same, but what about lung function and lung damage?
David: Unfortunately there is not as much of return on that. In fact, once the damage is done, there really isn’t much further that we can do at this point that’s been proven to improve lung function. However, what we can do, is – especially if they’re in the early stages of having the disease process is A- get an intervention done if they are continuing smoking, to stop -- getting help to be able to do that. We’ve changed our mindset over the years of how we treat tobacco dependence, and I say that in that it is an addiction to nicotine. Recently, in the last ten years, we’ve changed our mindset provider-wise and healthcare professionals to treat it more as an addiction versus actually just a bad habit.
Melanie: So then what are some of the treatments that are available and if exercise becomes a limiting factor and V-O-2, that amount of oxygen that’s consumed is tough to get, then exercise can sometimes be difficult for the person when that’s what they want to do as well.
David: Right. What we do have offered here at Aspirus is we do have free smoking cessation offered to any, and all patients here. That’s been a gradual build-up of exposure, trying to get patients who are interested in quitting smoking and giving them some tools and resources to try to be successful at that. But also, the other thing is once they are diagnosed with COPD, through true pulmonary function testing is we try to get them into what’s called a pulmonary rehab program. That’s where we try to reteach them not only habits of how they manage their breathing, but also, okay, let’s build up your exercise tolerance by having you learn different techniques for how you breathe. We reteach how they breathe and that helps them manage their symptoms better. The biggest thing is anxiety. I think that’s probably another factor that we have to keep in that concept of trying to do the overall treatment for these folks
Melanie: So David, let’s talk about teaching people to rebreathe because we’ve all heard about diaphragm breathing, but in pulmonary rehab, you teach a Valsalva, a way of holding your breath and releasing that air in tiny amounts. Speak about how that can increase that oxygen saturation and help people to get that breath that they’re missing.
David: Sure. Typically, what people want to do is they want to open their mouth wide when they’re having shortness of breath. What we try to do is reteach what’s called pursed-lip breathing. That pursed-lip breathing technique is basically almost like you’re trying to blow out a candle – think of – with really tight lips, or maybe – not that I play trumpet, but Imagine the same type of almost technique they would use for playing that type of instrument. What that does is – with COPD, what happens is the airways want to collapse down when they exhale out. By having that breathing technique of having them breathe in through the nose and pursed-lip out through the mouth, it actually helps splint the airways open and that way the airways aren’t feeling like they want to collapse down. We actually try to keep some back pressure – as layman’s terms –to keep those airways open as long as they can so they don’t collapse down.
Melanie: And what about when somebody does have to go on oxygen, what advice do you have for people that might have severe COPD -- and advanced -- and have to use oxygen.
David: Well, let’s face it, no one wants to have oxygen if they don’t have to, but once we’re able to do some education on the benefits of having oxygen, that helps a lot. It’s really a lot of discussion on the fears of that. One big thing is open flames or flammable material nearby. Oxygen isn’t combustible, but it helps support combustion. It’s not like gas where it would make a fire roar, but it will certainly add to a fire and be more enhanced because it is 100% oxygen. It’s more of teaching them the safety things. We still have people who are smoking up to this point so we try to really indicate you can’t have open flames, smoking a cigarette, or something like that. Also, looking at their activities of daily life, there's different sized tanks in that it can make them smaller, more manageable to carry around as well as portable, what are called concentrators. That’s a machine that actually takes air that we breathe out of air and concentrates the oxygen and delivers that through electronic machines
Melanie: So give your best advice, David, for staying healthy, avoiding exacerbations of their COPD and breathing problems and even avoiding things like pneumonia, which can really make this worse.
David: Yes, well the CDC certainly recommends obviously – especially those that have already the diagnosis of COPD to make sure that they do get a flu shot and that they do have a pneumonia shot during the indicated times. Those are probably some of the biggest things they can do preventative-wise. The other thing too is masking when you are having a cold, or if you are going to a clinic, we always ask folks to be aware of that, good hand hygiene, taking our medications as indicated. And then if we are having signs and symptoms that they're not feeling better, that they get in to see their provider right away. Our biggest challenge that we’re going to have is trying to reach those folks that are in that stage of they haven’t really gotten into the levels that they’re feeling really short of breath yet, but they probably are having a chronic cough, and that is really where we need to try to focus our attention to is to get those folks quitting smoking earlier so that they have a better chance of not going down that road.
Melanie: Really great information, David, thanks so much for being with us today. You’re listening to Aspirus Healthtalk, and for more information, you can go to Aspirus.org, that’s Aspirus.org. This is Melanie Cole. Thanks, so much, for listening.