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Living with COPD
Chronic obstructive pulmonary disease (COPD) is a disease that causes breathing-related issue and roughly 16 million Americans suffer from it. Living with it is difficult, but not impossible. Listen as Dr. Michael Alvarez, board-certified in internal medicine, pulmonary diseases, and critical care medicine at BayCare, discusses tips on how to live with COPD.
Featured Speaker:
Dr. Alvarez has special interest in advanced diagnostic bronchoscopy, including Navigational Bronchoscopy for lung nodules, Endobronchial Ultrasound for the diagnosing and staging of lung cancer and Cryo-Transbronchial lung biopsies for the diagnosis of Interstitial Lung Disease. He also has interest in the management of Pulmonary Hypertension.
Learn more about Dr. Michael S. Alvarez
Michael Alvarez, DO
Dr. Michael Alvarez is originally from Miami where he completed his undergraduate degree at the University of Miami and then went on to medical school at Nova Southeastern University. Dr. Alvarez also earned a master’s in public health while at Nova Southeastern. He completed his internal medicine training at the Cleveland Clinic Florida where he spent his final year as chief resident. He then moved to Tampa where he completed his fellowship in Pulmonary and Critical Care at the University of South Florida. He is board certified in Internal Medicine, Pulmonary Diseases, and Critical Care Medicine.Dr. Alvarez has special interest in advanced diagnostic bronchoscopy, including Navigational Bronchoscopy for lung nodules, Endobronchial Ultrasound for the diagnosing and staging of lung cancer and Cryo-Transbronchial lung biopsies for the diagnosis of Interstitial Lung Disease. He also has interest in the management of Pulmonary Hypertension.
Learn more about Dr. Michael S. Alvarez
Transcription:
Living with COPD
Prakash Chandran: COPD or chronic obstructive pulmonary disease is a disease that causes breathing-related issues. Roughly 16 million Americans suffer from it. And as you can probably imagine, living with it is difficult, but not impossible. Here to tell us more is Dr. Michael Alvarez. He's board-certified in internal medicine, pulmonary diseases, and critical care medicine at BayCare.
Welcome to BayCare HealthChat. My name is Prakash Chandran. And in this episode, we're going to be talking about living with COPD. Dr. Alvarez, thank you so much for joining us today. I truly appreciate your time. Let's get started with the basics. What exactly is COPD?
Dr. Michael Alvarez: COPD is defined as airflow limitation. Essentially, patients have trouble getting air out of their lungs and therefore have trouble getting air in and are short of breath because of this.
Prakash Chandran: Okay. And I know there's different types or subtypes of COPD. Can you talk about what they are and describe them briefly?
Dr. Michael Alvarez: Sure. So under COPD, which is an umbrella term, encompasses chronic bronchitis, which is usually defined as chronic cough over three months for two consecutive years. And this is seen mostly in smokers. You have emphysema, which is the actual destruction of lung tissue, which you can see on a CT scan or an actual pathology of lungs. And then, you have fixed obstructive asthma, which is usually a progression of some severe asthma form, which can lead to COPD.
Prakash Chandran: Okay. And out of curiosity, what exactly are the causes of COPD?
Dr. Michael Alvarez: So, the main cause of COPD is smoking. Smoking irritates the lung. It causes airway inflammation. It causes increase in mucin, a substance that access mucus lining of our airways, and this causes that chronic cough. And the smoking also causes that pathological destruction of the lung. And when you look at a CAT scan with somebody with emphysema, you'll see almost like Swiss cheese with holes in it because of smoking. There are other causes including organic dusts. There are noxious chemicals that can cause it as well. But overwhelmingly, the most common cause of COPD is smoking.
Prakash Chandran: So, I've also heard of something called asthma-COPD overlap. What is it and how common is it?
Dr. Michael Alvarez: So asthma-COPD overlap is a subset of people that had some intrinsic airway inflammation even in their youth, and they were asthmatics, labeled as asthmatics, which essentially is airway inflammation and difficulty getting air out. Then, they got introduced to some noxious stimuli like smoke and develop this obstructive component that is almost fixed. So asthma by definition is reversible. If I do a lung function test and I give you a breathing treatment, the reduction in lung function should go away with the breathing treatment. In patients that have progressed to asthma and COPD overlap, that obstruction persists despite the administration of medication.
Prakash Chandran: Okay. Understood. So, I want to take a step back and just briefly talk about how COPD is diagnosed in the first place.
Dr. Michael Alvarez: So, COPD is diagnosed based on symptoms and then objectively on lung function tests. So, most patients with COPD have some degree of shortness of breath, chronic cough, sputum production, occasionally some chest tightness or wheezing as well, but mostly that shortness of breath, chronic cough and sputum production. Those patients are then tested with what we call a pulmonary function test, which measure airflow in and out of the lung. And there are certain parameters that the patients need to meet to cross that threshold into COPD or obstruction.
Prakash Chandran: Okay. So, we're talking today about living with COPD. And I wondered if you could broadly talk about some of the treatments or therapies that are assigned when people have this.
Dr. Michael Alvarez: So for COPD, the mainstay of treatment is inhalers or what we call bronchodilators. They help to open up the airway and have good air flow in and out of the lung. They work also to decrease the inflammation in the airway to also reduce the amount of mucus that you're producing and, again, help open up those airways to allow patients to breathe easier as well. Other treatments are oxygen and then smoking cessation is probably one of the mainstay of treatments that these patients need to undergo.
Prakash Chandran: Okay. And are there any other non-pharmacological therapies or treatments that are worth mentioning?
Dr. Michael Alvarez: Absolutely. One of the better supportive measures for COPD patients is pulmonary rehab. This focuses on exercise endurance training, interval training, resistance and strength training, breathing retraining. All these things help patients feel better with COPD. They help patients improve their quality of life significantly, and even help reduce some hospitalization stays.
Prakash Chandran: Now, I know that when people kind of experience episodes, they're sometimes referred to as exacerbations. How would you suggest that people manage these exacerbations when they have them?
Dr. Michael Alvarez: So, COPD exacerbations are increasing in shortness of breath, increasing in mucus production, increasing in wheezing. And these exacerbations need to be managed with an acute intervention by a physician that knows what they're treating in terms of COPD. They have to be managed with frequent treatments in bronchodilators. They need to be managed with what we call steroids or prednisone to help decrease inflammation in that acute moment because, if it progresses, they can get into a dangerous situation and end up in the hospital.
Prakash Chandran: So, you know, we've covered here a lot today and especially a lot of treatments that people can use when they're living with COPD. Given all of your experience working with so many patients throughout the years, what is one thing that you wish more people did either before they came to see you or as they're thinking about living with COPD?
Dr. Michael Alvarez: So, one of the main things that I think people need to consider with living with COPD is all the adjunctive therapies that I mentioned, including with pulmonary rehab, some nutritional components and psychological therapy. What I tell my patients is, you know, your lung function has progressed to obstruction. You have COPD. It's not reversible, it's not coming back. So, we need to focus on things that can help you in every other aspect of your daily life to help with your COPD. I can't make your lung function better. But with pulmonary rehab, we can make you cardiovascularly more fit. We can teach you how to manage when you're having exacerbations. We can teach you things that help with your breathing, and these are things that are very helpful to live with COPD.
The other thing I would tell my patients is oxygen therapy when it's needed. So, patients that have oxygen that's below 88% need to go on oxygen therapy. This helps improve lifespan. In addition, smoking cessation is a huge aspect of treating COPD. If patients don't stop smoking, the inhalers are not going to work the way they're supposed to. They're not going to get to the receptors they're supposed to, and they're going to worsen their disease process.
Prakash Chandran: Well, Dr. Alvarez, I really appreciate this conversation today. I definitely learned a lot. Are there any final thoughts that you want to share with our audience before we close?
Dr. Michael Alvarez: I do want to share one thing. The majority of COPD patients are longtime smokers and they are at risk for lung cancer as well. And I do encourage anyone who has smoked one pack per day for 20 years, is actively smoking or quit smoking within the last 15 years and is over the age of 50 to go and get a lung cancer screening CT scan. Most patients with COPD likely qualify and it's an important aspect of treating you.
Prakash Chandran: Well, that is great advice, Dr. Alvarez. Thank you so much for your time.
Dr. Michael Alvarez: I appreciate you having me on. Thank you.
Prakash Chandran: And that wraps this episode of BayCare HealthChat. You can head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts. For more health tips and updates, follow us on your social channels.
If you found this podcast informative, please share it on your social media and be sure to check out all other interesting podcasts in our library. Thanks again. My name is Prakash Chandran, and we'll talk soon.
Living with COPD
Prakash Chandran: COPD or chronic obstructive pulmonary disease is a disease that causes breathing-related issues. Roughly 16 million Americans suffer from it. And as you can probably imagine, living with it is difficult, but not impossible. Here to tell us more is Dr. Michael Alvarez. He's board-certified in internal medicine, pulmonary diseases, and critical care medicine at BayCare.
Welcome to BayCare HealthChat. My name is Prakash Chandran. And in this episode, we're going to be talking about living with COPD. Dr. Alvarez, thank you so much for joining us today. I truly appreciate your time. Let's get started with the basics. What exactly is COPD?
Dr. Michael Alvarez: COPD is defined as airflow limitation. Essentially, patients have trouble getting air out of their lungs and therefore have trouble getting air in and are short of breath because of this.
Prakash Chandran: Okay. And I know there's different types or subtypes of COPD. Can you talk about what they are and describe them briefly?
Dr. Michael Alvarez: Sure. So under COPD, which is an umbrella term, encompasses chronic bronchitis, which is usually defined as chronic cough over three months for two consecutive years. And this is seen mostly in smokers. You have emphysema, which is the actual destruction of lung tissue, which you can see on a CT scan or an actual pathology of lungs. And then, you have fixed obstructive asthma, which is usually a progression of some severe asthma form, which can lead to COPD.
Prakash Chandran: Okay. And out of curiosity, what exactly are the causes of COPD?
Dr. Michael Alvarez: So, the main cause of COPD is smoking. Smoking irritates the lung. It causes airway inflammation. It causes increase in mucin, a substance that access mucus lining of our airways, and this causes that chronic cough. And the smoking also causes that pathological destruction of the lung. And when you look at a CAT scan with somebody with emphysema, you'll see almost like Swiss cheese with holes in it because of smoking. There are other causes including organic dusts. There are noxious chemicals that can cause it as well. But overwhelmingly, the most common cause of COPD is smoking.
Prakash Chandran: So, I've also heard of something called asthma-COPD overlap. What is it and how common is it?
Dr. Michael Alvarez: So asthma-COPD overlap is a subset of people that had some intrinsic airway inflammation even in their youth, and they were asthmatics, labeled as asthmatics, which essentially is airway inflammation and difficulty getting air out. Then, they got introduced to some noxious stimuli like smoke and develop this obstructive component that is almost fixed. So asthma by definition is reversible. If I do a lung function test and I give you a breathing treatment, the reduction in lung function should go away with the breathing treatment. In patients that have progressed to asthma and COPD overlap, that obstruction persists despite the administration of medication.
Prakash Chandran: Okay. Understood. So, I want to take a step back and just briefly talk about how COPD is diagnosed in the first place.
Dr. Michael Alvarez: So, COPD is diagnosed based on symptoms and then objectively on lung function tests. So, most patients with COPD have some degree of shortness of breath, chronic cough, sputum production, occasionally some chest tightness or wheezing as well, but mostly that shortness of breath, chronic cough and sputum production. Those patients are then tested with what we call a pulmonary function test, which measure airflow in and out of the lung. And there are certain parameters that the patients need to meet to cross that threshold into COPD or obstruction.
Prakash Chandran: Okay. So, we're talking today about living with COPD. And I wondered if you could broadly talk about some of the treatments or therapies that are assigned when people have this.
Dr. Michael Alvarez: So for COPD, the mainstay of treatment is inhalers or what we call bronchodilators. They help to open up the airway and have good air flow in and out of the lung. They work also to decrease the inflammation in the airway to also reduce the amount of mucus that you're producing and, again, help open up those airways to allow patients to breathe easier as well. Other treatments are oxygen and then smoking cessation is probably one of the mainstay of treatments that these patients need to undergo.
Prakash Chandran: Okay. And are there any other non-pharmacological therapies or treatments that are worth mentioning?
Dr. Michael Alvarez: Absolutely. One of the better supportive measures for COPD patients is pulmonary rehab. This focuses on exercise endurance training, interval training, resistance and strength training, breathing retraining. All these things help patients feel better with COPD. They help patients improve their quality of life significantly, and even help reduce some hospitalization stays.
Prakash Chandran: Now, I know that when people kind of experience episodes, they're sometimes referred to as exacerbations. How would you suggest that people manage these exacerbations when they have them?
Dr. Michael Alvarez: So, COPD exacerbations are increasing in shortness of breath, increasing in mucus production, increasing in wheezing. And these exacerbations need to be managed with an acute intervention by a physician that knows what they're treating in terms of COPD. They have to be managed with frequent treatments in bronchodilators. They need to be managed with what we call steroids or prednisone to help decrease inflammation in that acute moment because, if it progresses, they can get into a dangerous situation and end up in the hospital.
Prakash Chandran: So, you know, we've covered here a lot today and especially a lot of treatments that people can use when they're living with COPD. Given all of your experience working with so many patients throughout the years, what is one thing that you wish more people did either before they came to see you or as they're thinking about living with COPD?
Dr. Michael Alvarez: So, one of the main things that I think people need to consider with living with COPD is all the adjunctive therapies that I mentioned, including with pulmonary rehab, some nutritional components and psychological therapy. What I tell my patients is, you know, your lung function has progressed to obstruction. You have COPD. It's not reversible, it's not coming back. So, we need to focus on things that can help you in every other aspect of your daily life to help with your COPD. I can't make your lung function better. But with pulmonary rehab, we can make you cardiovascularly more fit. We can teach you how to manage when you're having exacerbations. We can teach you things that help with your breathing, and these are things that are very helpful to live with COPD.
The other thing I would tell my patients is oxygen therapy when it's needed. So, patients that have oxygen that's below 88% need to go on oxygen therapy. This helps improve lifespan. In addition, smoking cessation is a huge aspect of treating COPD. If patients don't stop smoking, the inhalers are not going to work the way they're supposed to. They're not going to get to the receptors they're supposed to, and they're going to worsen their disease process.
Prakash Chandran: Well, Dr. Alvarez, I really appreciate this conversation today. I definitely learned a lot. Are there any final thoughts that you want to share with our audience before we close?
Dr. Michael Alvarez: I do want to share one thing. The majority of COPD patients are longtime smokers and they are at risk for lung cancer as well. And I do encourage anyone who has smoked one pack per day for 20 years, is actively smoking or quit smoking within the last 15 years and is over the age of 50 to go and get a lung cancer screening CT scan. Most patients with COPD likely qualify and it's an important aspect of treating you.
Prakash Chandran: Well, that is great advice, Dr. Alvarez. Thank you so much for your time.
Dr. Michael Alvarez: I appreciate you having me on. Thank you.
Prakash Chandran: And that wraps this episode of BayCare HealthChat. You can head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts. For more health tips and updates, follow us on your social channels.
If you found this podcast informative, please share it on your social media and be sure to check out all other interesting podcasts in our library. Thanks again. My name is Prakash Chandran, and we'll talk soon.