Caitlin Whyte (Host): Welcome to Hally HealthCast, the wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic important to your health and well-being. Bringing in expert doctors, specialists, and other health experts who offer advice and answer your most pressing questions.

Today's episode is all about chronic obstructive pulmonary disease, or COPD, and pulmonary rehabilitation. November is COPD Awareness Month, so it's the perfect time to learn more about COPD and how we can improve the lives of those affected by this disease, including treatments such as pulmonary rehabilitation.

Here with us is Sarah Moore. She is a Respiratory Care Practitioner Coordinator at Carle Foundation Hospitals' Pulmonary Rehabilitation Department in Urbana. Welcome Ms. Moore and thank you so much for being with us today and sharing your knowledge.

Now, let's begin by taking a deep breath and being grateful for being able to do so, because that's really what's at stake with today's topic. Now, Ms. Moore, can you explain for us, please, what exactly is COPD, what are its symptoms, and what causes it?

Sarah Moore: Well, I want to thank you so much for having me, first of all. COPD stands for Chronic obstructive pulmonary disease, and it's a group of chronic inflammatory lung diseases that cause obstructed airflow from the lungs. The common forms are emphysema, chronic bronchitis, and chronic asthma. Those are the three that fall under the COPD umbrella. And the most common symptoms that people have with COPD include shortness of breath, cough, mucus production, wheezing, chest tightness, a lack of energy, and frequent respiratory infections.

Some of the possible causes and/or risk factors for COPD. Long-term exposure to lung irritants like tobacco smoke or chemicals can damage your lungs and airways causing COPD. The leading cause of COPD is smoking. However, what most people don't realize is that one in four people living with COPD never smoked. So, I think that's a common misconception. Some risk factors for COPD include a history of childhood respiratory infections, smoke exposure from maybe a coal or wood-burning stove, exposure to secondhand smoke or other chemicals, and also genetic disorders such as alpha-1 antitrypsin deficiency, which is an inherited condition that affects the body's ability to produce a protein to protect the lungs, and so you get COPD from that.

Host: Wow. Well, thank you, Ms. Moore. That was marvelously instructive. It certainly sounds like COPD can literally take your breath away. So, how do people with COPD manage its symptoms and are there any effective treatments for this condition?

Sarah Moore: COPD can be managed by quitting smoking, first and foremost, if you're still a smoker; pacing yourself, being mindful of fatigue and overexertion in your daily activities; taking your prescribed medication regularly as prescribed; going through a pulmonary rehab program; getting your vaccinations; eating a healthy, well-balanced diet, things of that nature.

And then, the main treatments for COPD are medications and pulmonary rehab. So, medications play a huge role in managing COPD symptoms. The first line of defense in COPD are your bronchodilators, sometimes referred to as your rescue medications. These are your albuterol inhalers or albuterol nebulizer. They come in a lot of different names, so Pro Air, Ventolin, Combivent, or DuoNeb. Those are all similar medications. In addition to these short-acting inhalers, there are also longer-acting bronchodilator medications. So, Spiriva, Incruse, Brovona might sound familiar to some patients.

Another treatment for COPD is inhaled steroids. And these are inhalers that can reduce your airway inflammation and help prevent flareups. And then, there are combination inhalers that are very effective in treating COPD as well. And they work in different ways in your body to improve your breathing. So, they combine the long-acting bronchodilators that I talked about with the steroids. So, instead of taking three different medications or two different medications, you have those medications all-in-one inhaler. So, sometimes it's a Trelegy or Breztri, those are triple-action medications. And then, you have your oral steroids, oral antibiotics if the patient's having a flareup, and also oxygen. Some people with COPD require supplemental oxygen. This can improve the patient's quality of life and help with shortness of breath.

Another vital component of COPD care is pulmonary rehab. Pulmonary rehab programs combine education, exercise training, nutrition advice, and counseling. And the main goal of pulmonary rehab is really to improve patients' quality of life.

Host: Well, thank you, Ms. Moore, for that splendidly thorough answer. It's so great to know that there are so many viable treatment options available for people with COPD. Now, clearly, pulmonary rehab is something that you're well-versed in. So, can you tell us more about what's involved for a typical patient in pulmonary rehabilitation?

Sarah Moore: I would love to. In pulmonary rehab, each patient begins the program with a one-on-one consult with trained staff, where a number of assessments are completed, including a six-minute walk test. And then, these tests allow our therapist to come up with an effective treatment plan for the patient, and we set goals for every patient. And then, from there, patients attend exercise classes two to three days per week.

A typical program runs about three months, 8 to 16 weeks. And the focus of these exercise classes are flexibility, strength training, endurance exercises, and then education. Each day includes practicing breathing techniques, pacing, working to reach their goals, and improve their quality of life. And over the course of the program, with consistency, patients can learn to manage their breathing, they gain strength, they gain endurance, and usually, form healthy habits, and even make a few friends.

Host: Oh, I love that. That is so impressive and so fun to meet other people. Well, there really are a lot of ways it sounds like that pulmonary rehab can help people with COPD manage their symptoms and find a few friends. So, how can people who need this kind of help connect with pulmonary rehab programs? And then, what kind of considerations are there for participation?

Sarah Moore: Patients can be referred to pulmonary rehab program by talking to their primary care physicians or if they have a pulmonologist, a lung doctor, they can ask them to refer. Really, any doctor or nurse practitioner can refer a patient to pulmonary rehab. From there, there are some qualifications that patient must meet.

And one of these qualifications is to have a qualifying pulmonary function test. So if a patient has been diagnosed with COPD, they have already most likely had this test. It's a breathing test. Their PFT has to meet certain qualifications. Basically, they have to be bad enough. They have to have moderate to severe COPD, not mild. In addition to that, the patient must be able to transfer on their own. So even if they can't walk far, they need to be able to move from machine to machine, and be able to transfer. And then, they also need to be able to consistently attend exercise classes, you know, for the most part. We understand if they have appointments or something. But the consistency is key, so be able to attend, you know, two to three days per week for several weeks. And then, patients should check with their insurance providers to ensure coverage for pulmonary rehab.

Host: Of course. Well, thank you, Ms. Moore. Definitely some important and ultimately beneficial information there. But in this weird new post-pandemic world, I still have to ask, are there any remote or home based options for these programs? I mean, we were even chatting offline just a few minutes ago. I work from home. I don't even want to leave my house, regardless some days. So how do these compare to the advantages and/or challenges of in-person rehab?

Sarah Moore: Right. Yeah. So, two home-based remote options that I'm aware of, one's Channel Health and another is called Carda Health. And these programs state that they offer pulmonary rehab at home. During the pandemic, actually, when our local pulmonary rehab offices were forced to close for about four months, we partnered with Channel Health, because we wanted to be able to reach our patients and provide home-based therapy while we were closed down. And it was so important to stay in touch with them. And using this Channel Health app, we were able to upload videos for patients to use at home that helped them to stay active. They were able to do stretching, weight training, resistance bands, and exercises at home. We couldn't visualize them when they were doing these exercises. They were able to download the app and then, check their vitals and send them to us. This mainly consisted of walking, sit-to-stand exercises, unless they were fortunate enough to have some equipment at home, such as a treadmill, or some people had an exercise bike. But for the most part, they were just walking at home and they were able to monitor their oxygen saturations. They were using the same shortness of breath scale that they used when they were here at our facility, so they could let us know how they were feeling and they could send the results to us via the app. It was definitely good. It was something that we could do and provide and communicate with them through that and let them feel like we were still connected to them.

So, I think the main downfalls of home-based programs compared to in-person pulmonary rehab are two things, the lack of social connection and the lack of equipment at home. We found that a huge part of in-person pulmonary rehab that doesn't get talked about a lot is the positive psychosocial aspect of exercising together with a small group of people who are in a similar situation as you. When exercising together and having staff encouraging and supporting them, patients gain confidence, they learn new things, they meet new people with similar struggles, kind of what we talked about earlier, and then they really encourage one another. That means so much to patients. We found that after the pandemic, actually, many patients realized what a great privilege it is to be able to exercise together and support one another, and they actually look forward to it. So, we've had a lot better turnout post-pandemic, I think, because people don't take it for granted anymore. And so, It's really an important part of pulmonary rehab, in-person in a facility, just people being there for one another.

But that being said, for patients who lack transportation or access or maybe their schedules are nontraditional. They still work, you know, if they're younger and they still work during the daytime when our classes are, home-based pulmonary rehab can offer them greater flexibility in when and where they can exercise, which promotes better outcomes.

Host: Absolutely. I do love that side benefit you mentioned of just kind of community and being able to relate to people and talk about all the struggles you're going through, maybe with someone with similar struggles. So, that's just lovely to hear that there's kind of that friendship built into these group classes. And another terrific example of why it's just good to have all these options. Like you said, work gets in the way and schedules can be crazy.

But let's look ahead now to life beyond just the pulmonary rehabilitation. Do you have any tips or advice for anyone looking to successfully adapt their lifestyle to living with COPD post-rehab? For example, are there some breath techniques or exercises or special diets you recommend? Or perhaps just a few resources that pulmonary rehab patients can access on their own?

Sarah Moore: Well, the most important thing to do after completing a pulmonary rehab program is to keep it up. That's the main thing. You know, you've worked so hard, people have gained so much out of the class endurance-wise, they're breathing better, they know what to do as far as these different breathing techniques. So, they just have to keep using it. Take all the things you've learned in the program, continue applying them in your lives. The best way to stay healthy and out of the hospital, really, is to continue to exercise somewhere. Continue to monitor your oxygen saturations, your heart rate, your level of breathlessness. Continue to stretch daily, as well as using light weights or resistance bands a few times a week, probably three or four times a week at least. And then, continuing to eat well, to eat to fuel your body, drinking plenty of water, and not smoking, that's a big one.

Carle Pulmonary Rehab, actually we offer a maintenance program. So when you're in the main pulmonary rehab program, it's called Phase 2. And then, once you are finished with your three-month program, you move to Phase 3 or Maintenance, and that's kind of where the rubber hits the road as far as we've found that it's easier for patients to come in when they're scheduled three days a week. But when they have to make themselves come in or make themselves exercise, that's when excuses, things, life happens. We try to make it easy at Carle to do that. We offer Phase 3 at different times, but five days a week. And it's $3 per session, so pretty affordable. It's not built to insurance. But some health insurance plans have a wellness program, so the BFIT, where that's covered, and then Silver Sneakers also. There are support groups. Here at Carle, we have a Carle Pulmonary Rehab Support Group Facebook page. So, this is a virtual support group that connects people that are living with lung disease. A lot of people that have been through our program, and they can bounce ideas off of one another. That's really, really helpful. And then, some different websites that are good, copdfoundation.org, the American Lung Association, American Thoracic Society, and then the Global Initiative for Chronic Obstructive Lung Disease. Those are all reliable sources on the internet that have some really good information.

Host: Oh, wonderful. Well, thank you for that heaping helping of great information, Ms. Moore. It's so important to have a wealth of support and resources, just like you mentioned, when facing a major health challenge like COPD. Well, certainly, we've learned a lot today about COPD and what's involved in managing its potentially debilitating symptoms.

But in the interest of ending on a positive note, Ms. Moore, how about we wrap up this discussion with a quick update on any recent advances in COPD care and research that we should know about, topped off with one of your favorite success stories from your experience in coordinating respiratory care and pulmonary rehabilitation at Carle Foundation Hospital.

Sarah Moore: Well, there are a couple of newer, recent advances in COPD care and research. One thing I touched on briefly earlier is the triple therapy in one inhaler. So, that's an advancement that's come into COPD treatment market in the last several years. So like I said, that's three medications that work in different ways together to help patients to breathe better. And usually, they are good for a full 24 hours. So, it really helps patients to be able to just take one, you know, one or two puffs, and they don't have to think about it until the next day, rather than, you know, every four hours. So, that's really come a long way.

And then, there was one inhaler called Ellipta form, and then another one now has come on the market, which it's called HFA form. This one can be used, it's like your traditional inhaler form, like a rescue inhaler. So, it's a little bit easier for patients to understand, and it can also be used with a spacer, which is a device that keeps the medication in that device until you can take the deep breath in. You don't have to coordinate the pushing of the inhaler and breathing it at the same time, which can be stressful for patients. That's been a good one.

And then, another even newer advancement are biologics, which are medications that are produced using DNA technology. They've been on the market for quite some time for asthma and now they're becoming available to treat COPD. So, this is really important, because biologics can open up a new era in the treatment of COPD and hopefully they can offer patients new and more effective remedies to treat their disease. So, that's been really good.

And then, let's see, one of my favorite success stories. I have to say, I've seen so many success stories throughout my years in respiratory care and specifically at pulmonary rehab. Every single day, our team gets to bear witness to patients getting closer to achieving their goals, both large and small. Some of the most impactful moments are when we get to help change people's lives for the better. So many people come into Pulmonary Rehab after a flareup or hospitalization where they have deconditioned to the point of being short of breath, really just doing activities of daily living around their home. They can get really discouraged. They can't imagine being able to exercise when they just get short of breath walking to the restroom or around their home. They sometimes lack hope and they start coming here. And with consistency in the Pulmonary Rehab Program, with education and pacing themselves, and gradually increasing their endurance, we find that they're able to breathe better and they're just able to enjoy their lives so much more. They can build their confidence and they learn how to pace themselves. They kind of get that sunshine back in their lives and they're just so grateful.

One patient that comes to mind though, we had a wonderful patient that she came in and one of her goals was to walk on the beach again. She just wasn't sure if she would be able to reach the goal. She had a trip planned to Florida, but she figured she would just go, but not actually be able to get on the beach because of the sand, and it was difficult. So, she was doing her classes. She didn't like the treadmill. She was kind of afraid of it. She had some pain, and she didn't really want to walk on it, even though she knew she could. So, our staff kind of gently reminded her, you know, encouraged her to do it, and gently reminded her that if she didn't walk on the treadmill, there's no way she was going to make it to walking on the beach. So each session, this patient walked just a little bit more on that treadmill. And by the end of the three-month program, she was on the Florida beach, toes in the sand, and she sent us pictures to prove it. It was a joyous occasion for all of us. It was wonderful.

Host: Oh my gosh, I love hearing about that connection you have with your patients and getting those pictures and just really being able to celebrate with them. That sounds so, so rewarding.

Sarah Moore: It absolutely is. It's great.

Host: Well, Ms. Moore, you've been an absolute pleasure to have on our podcast. Thank you so much for joining us and for all that you do every day at Carle Foundation Hospital's Pulmonary Rehab Department for so many people and families. That concludes today's Hally HealthCast. Tune in next time as we tackle yet another topic important for your health and well-being. And remember, Hally Health is your partner in helping you live your healthiest life. Visit hally.com, that's H-A-L-L-Y.com, for resources, information, tips, and much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in again.