Scott Webb (Host): Today we're checking in with Dr. Vishesh Paul, Pulmonologist with Carle on the latest in COPD management, including the importance of genetic testing and the latest in treatment options.  

Doctor, it's so nice to have you here today. We're going to get some updates, if you will, on COPD, COPD management. Share that with the audience. So let's talk first about genetics, right? I know that genetics plays a factor in this, so maybe you could discuss the importance of checking our genetics to find out if we're more susceptible or not.

Vishesh Paul, MD: Yes. Let's start with this important topic. The genetics we refer to here is it's a disease. I'll keep it simple. It's called alpha one antitrypsin. It's a genetic disease. If some people have, enzyme deficiency with this, and anybody who has severe COPD actually should be tested for it. In this disease, people are missing the protection that lung naturally should have. So if they get exposed to even a little bit of smoke or occupational exposures, they will develop COPD much faster. So currently, all the national and international guidelines, recommend that anybody with COPD should be tested for this genetic disease called alpha one antitrypsin.

And the reason is we can counsel them on smoking cessation better. Second, they can have other diseases like liver and skin problems that can be prevented and if we diagnose the problem, there is treatment for it. We can give weekly injections and help save the lung and other organs.

Host: Yeah, so you give us a good sense there, the importance of if you have COPD, checking the genetics, who's more susceptible, all of that. I want to have you talk about lung cancer screening as it relates to, you know, updating folks on current guidelines or the value, whatever it might be.

Vishesh Paul, MD: For decades, women have been getting the pap smear and men and women both get the colonoscopy, men get the prostate exam. These are part of screening tests for cancer. In last couple of decades, there has been a lot of interest in lung cancer screening because lung cancer is the leading cause of cancer related death in the US.

 So any prevention has far greater impact on reducing mortality. So, anybody who has smoked more than 20 pack years or 20 years of smoking and are between 50 and 80 years of age, and they're currently smoking or have quit within last 15 years, they should be screened for lung cancer. And how do we screen?

We do a low dose CAT scan, not like a traditional CAT scan. This one is a much lower dose, about one eighth of radiation dose, once a year. This helps us identify if there is any new spot in the lung that could potentially grow into cancer. Identify it early. Treat early and cure the patient. That's the goal.

Host: Right. That's definitely the goal. Early diagnosis, treatment, curing patients, love hearing, all of that. Want to have you talk about some of the newer treatment options. So, what's the latest doctor?

Vishesh Paul, MD: In regards to treatments, the basic of COPD, first of all is inhalers. Every few months or every year, we have new inhalers and nebulizers coming out into the market, and they help. In last few years, the focus has been to combine the inhalers. So a person does not have to do two or three inhalers multiple times a day.

Instead, they are doing one inhaler once a day or twice a day, so that if I'm a patient I can do that much better. It's cheaper. I have a better compliance success of doing that and better tolerated, so that's one. Second, now, in last year or two, we have identified that some patients with COPD have a particular type of inflammation, which the doctor can identify. If these people are having symptoms despite inhaler therapy, we have introduced injections just like insulin injections that they take once every two weeks or three weeks or four weeks, and that can improve their symptoms, reduce these flareups and prevent hospitalizations, and we are seeing excellent results with those.

Host: That's great to hear. Like lots of options for patients and as you stressed earlier, early diagnosis, early treatment leads to good outcomes, great outcomes, really. How about some of the non-pharmacological treatment options?

Vishesh Paul, MD: I think they hold equal weight as pharmacological options of inhalers. Non-pharmacological treatments actually help our COPD patients, sometimes I believe even more than the inhalers and medications. So, first of all, smoking cessation is the most important. That helps your lungs and other organ systems, and we have different therapies for that.

Second, we talk about vaccinations. Every year we get this seasonal flu vaccination, the Pneumococcal vaccination, and even now RSV vaccination. We suggest people with COPD to get these. It prevents severe disease or infections in such people. Another important aspect is nutrition support.

There is no ideal COPD diet, but extra weight, if there is, it can contribute to shortness breath. So we always encourage to maintain a healthy body mass index, which is also known as BMI. And one of the most important things, which at least I have found and my colleagues also agree is the pulmonary rehab.

People should ask their doctors and providers about pulmonary rehab, anybody with COPD. We have a very specific patient or person tailored program on how their exercise capacity is, how their comorbidities are, and we enroll them in an exercise program suited for their needs and depending on their capacity, and slowly build their strength, improve their exercise tolerance, strengthen their breathing muscles, and improve their breathing capacity.

And we see excellent results. It improves what people are able to do, their quality of life, and we have seen other benefits also in their psychological life.

Host: Hmm. Interesting. Yeah, that's nice to hear. We all want to believe we have options, of course. So options that may lead to great successes. And so it sounds like folks are in good hands with Carle, with you and the team there. I just give you a chance here at the end, I like to ask this sometimes of guests, like, what do you wish folks knew about COPD?

Like, what do you think we get wrong or don't know? Or there's misinformation, like dispel a myth or however you want to put it, but what do you wish folks knew about COPD management?

Vishesh Paul, MD: A lot of times we see people who are 50-year-old. And they're diagnosed with COPD that it is end of life. It's usually not. Treatments have evolved. We have people who are diagnosed with COPD at age of 50, 55, 60, and if they work on that themselves, smoking cessation, right? Inhalers. I think their quality of life and longevity can definitely, definitely improve significantly and that holds for people in 60 and 70.

Also, it's not late. There is room for improvement. There is room for getting better.

Host: Yeah. That's great to hear. Yeah, it's a, again, it's nice to hear these things from an expert and knowing that it's really almost never too late, of course, to improve your health, your quality of life, all of that. Thank you so much for your time today. Appreciate it.

Vishesh Paul, MD: Thank you much. My pleasure.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.