Transcription:

Prakash Chandran: Like other respiratory illnesses, COVID-19 can cause lasting lung damage. We're slowly starting to understand more about the disease and why it's so important to keep your lungs healthy in this new COVID world. We'll be talking about it today with Dr. Faisal Khan, the Medical Director of the Interventional Pulmonary Clinic at Franciscan Health at the Indianapolis campus. I'm Prakash Chandran and this special COVID-19 podcast is brought to you by Franciscan Health and was recorded on June 9th, 2020. So Dr. Khan, great to have you here today. Let's talk about the lungs. Why exactly is it so important to be lung healthy, especially now?

Dr. Khan: So Prakash, thank you so much for inviting me. So yes, in regards to lung with this COVID-19 situation, the lung health has taken a center stage. And traditionally, when we talk about staying healthy lung is not the first organ that comes to mind. But having said that, one has to recognize that lung is the only organ system that is directly exposed to the environment. And normally we have defense systems in the lung, which protect us against air pollution and some germs and keep them at Bay, but those systems have some limitations and this is becoming more forefront with the COVID-19 situation. So it's very important to prioritize the lung health, not only to protect our lungs, but we have to also recognize that a diseased lung also directly or indirectly effects other organ systems in the body like heart and bone, and actually causing more psychological issue like depression. So there's a whole host of other indirect and direct effects if your lungs are not healthy. So very important to keep a good check on your status of your lungs.

Host: And so when we talk about prioritizing the lung health, what are some ways to get lung healthy?

Dr. Khan: So the fundamental concept we have to recognize is that lungs are primarily designed to exchange air. So they are not meant for anything other that can be inhaled in them. So in that regard, what we have to make sure is few common sense things. One is smoking is a big factor. If you are a smoker, start thinking about ways in seeking out avenues to cut down and quit smoking. If you're not a smoker, then don't even think of smoking. And in this day and age, one of the other potential challenge we are facing is the vaping issue. So that goes hand in hand with the smoking as well. There's a myth out there that vaping might be beneficial or not as harmful. And that's not true. There's no safe form of smoking. So things like hookah or cigars, they're not any better than regular cigarettes.

So again in general bottom line is smoking is not good for lung health and that's one of the major driver of lung disease in this society. Having said that there are other things we can focus on. One is the quality of air we are breathing. So general cognition of indoor pollutant. So making sure that our ventilator systems in the homes and workplace are well maintained. And if there's any concern about air quality, then we should be getting that checked. The same is true with the occupational exposures. If you're in certain occupations where there's a lot of air pollution or dust, then following standard protective guidelines to wear masks and other protective equipment’s to avoid inhaling those chemicals. Same is true with if you have any underlying lung disease like asthma, then being cognizant of the air quality, especially in summers when there are no zone days and the air quality is bad, then don't go out as much because that can aggravate the lung disease.

Then the other things we can do to help lung is preventing infection. So COVID-19 a good example of that, that when we have an epidemic like this, then making sure we are doing proper health maintenance things like hand washing, wearing masks avoiding exposure unnecessarily to this population. And then also making sure that we are immunized against pathogens, where we have immunization available. So up to date on influenza vaccine, up to date on pneumonia vaccine. And those are the questions we should be asking our healthcare providers when we go and see them for routine care, that whether I should be getting this vaccine or not. So that's another way of helping your lungs. And the last, but not least is exercise. We don't correlate exercise with lung health as much, but exercise has its benefits.

Not only indirectly making our lungs more efficient and oxygen exchange, but also improving the coordination of lungs with the other organ systems like heart to make the whole cardiovascular respiratory system more efficient. It also adds to the strength of the respiratory muscles, which help us move the rib cage. So, and that in in a way also helps improve our STEM and overall lung health. So and then the last I would want to mention is the regular checkups. If you have any symptoms related to your lungs and they're not going away seek out medical assistance.

Host: Right. So, when you say that regular checkup, like if you have, I'm assuming some sort of chronic cough, or if you have been a smoker for awhile, there are ways that you can get it checked to make sure that you are as healthy as possible. Is that correct?

Dr. Khan: Yes. So, the fact is that the different lung diseases manifest as very common symptoms. So the symptoms are not specific, but they can be a sign of something minor or major. So things like persistent cough that is not going away for months symptoms like shortness of breath, which is new and gradually getting worse, symptoms like coughing up even small amount of blood that is happening off and on, and swelling in your legs. So chest pain, chest tightness. So if those are the symptoms you're feeling and they're not going away after a few days, then I think that is a sign that you should be seeking out because they can be a sign of something more serious happening.

Host: So I want to get into some of the more common lung issues that you see. Can you maybe talk a little bit about them?

Dr. Khan: So the common lung problems, which are actually slightly on the rise are COPD or commonly known as sometimes emphysema, chronic bronchitis, then you have asthma. There's a common myth that asthma typically happens only in younger age. Now, there is also a significant proportion of asthma happening in later in life without any history in the past. And then lung cancer incidents is also on the rise not only in the smoking population, but nonsmoking population, as well as non-smoking women. We don't understand the full reasoning behind that, but that's a demographic that is gradually on the rise as well. So I can go into details of each of these disease process if you would like?

Host: Yeah, why don't we dig into it a little bit, just so our audience can understand what they should expect with each one.

Dr. Khan: So in COPD is primarily because of history of a previous smoking or active smoking and can also happen due to certain occupational exposures. And very rarely it can happen if someone is born with a certain genetic defect. Having said that the common symptoms of COPD typically present after the age of 40, 45, and usually it's a slow onset with shortness of breath, sometime mild cough. And as time progresses, those symptoms get more activated. One starts to feel more shortness of breath with exertion, more cough, productivity of phlegm. Sometime it also causes some chest discomfort on severe and exercise and sometime dizziness, if the oxygen is staying low, a disturbance in sleep. So those are the general symptoms, and they keep on gradually getting worse with time.

There's also risk of having more frequent pneumonias or flare up during, especially during winter months. So that being said in regards to asthma and now asthma symptoms can also mimic COPD or emphysema symptoms. But what asthma is, is basically a sensitivity to something in the environment. So typically you'll have symptoms of cough, shortness of breath, chest tightness, sometime wheezing, but there is usually a relationship to or a history of certain exposure precipitating those symptoms. So that can be exposure to certain season like allergens or pollen or some indoor stuff like perfumes and cleaning agents. And some people do just have a trigger with asthma of I'm sorry, with the exercise that they are not sensitive to anything else, but when they start work out, they start having chest tightness and wheezing and shortness of breath five to 10 minutes into the exercise.

So those are all signs of asthma. Now as primarily a disorder of your ear tubes that go into the lungs. So they get more inflamed, tighter in their diameter and that makes it hard for the airflow to go in and out. In regards to lung cancer, lung cancer typically again, the majority of the time, the risk factor is a history of smoking, usually average smoking of one pack a day for more than 30 years that's a high risk population, but it also runs in the family. There can be other environmental agents like radon exposure over many years can cause that, especially in Midwest here. And again, the symptoms of lung cancer can be very nonspecific, chronic cough, weight loss, sometimes off and on coughing up blood, shortness of breath, getting worse, chest pressure. And those are the very nonspecific symptoms, but if the symptoms are lingering, then that's where you go in and get yourself checked. Luckily with the lung cancer now, there is some hope in the screening, reliable for high risk population in where screening is available for a certain subset of people who are considered high risk.

Host: Okay. And so you mentioned COPD, you mentioned asthma and lung cancer. I'd like to move to the diagnostic tools or the treatment options that are available for each one, if you can speak to that a little bit.

Dr. Khan: So for COPD, the main diagnostic tools are of course when someone sees a clinician, they will go over to the basic history and kind of figure out whether their risk factors present in the history for COPD, but for, from a patient experience standpoint the first test that is typically done is what we call a pulmonary function test or a PFP. And that gives an idea of the airflow in the lung, the lung capacity in general, and the efficiency of the lung in terms of transporting oxygen across from lung into the blood. And based on those numbers, we can have a pretty decent idea whether this is falling into COPD, chronic bronchitis category, or some other disease process. Chest X-ray, or a CT scan of the chest is also sometimes done, if there's any question in the clinician's mind to further investigate, and there are certain classical changes on those imaging that that can swing their opinion one way or the other, whether this is looking like COPD or not.

In terms of asthma, again, a history and physical examination is very important, clues in the history in regards to environmental sensitivities and all that. And then again, the first step is also to do a pulmonary function test and see the pattern of airflow on those tests to kind of figure out whether this is more mimicking asthma or not. One thing in the asthma is typically people who have asthma when you do a breathing test, and then you repeat a breathing test after giving them a bronchodilator, or a medicine, which dilates your airways, then you see a significant response in the airflow, in terms of improvement. There are other tests which are more sophisticated to further pinpoint what type of asthma this could be but not the forum to discuss this, but that's the basic test where people start from then for lung cancer. Again, the basic workup is if there is suspicion on history and physical, that there could be lung cancer, then a CT scan of the chest is the first go to test to look at the lung itself and the airway itself, and the physical architecture of those organs. So those are the basic workups for the most common disease processes we have discussed.

Host: Got it. And so, just as we close here, I want to bring this back to the world that we're living in now with COVID-19, you know, we hear that some of the most common symptoms that someone might experience, they have it is that shortness of breath and that dry cough. Can you maybe talk a little bit about how that is correlated to the lung health?

Dr. Khan: Yeah. So if someone has shortness of breath and chronic cough, that is typically a sign of some disease process in the lung, and typically these symptoms are a result of inflammation in the lung. Now there are different disease processes, as we discussed that cause inflammation either directly or indirectly, or these could be also signs of some sort of irritation in the airways or the lung as like in case of lung cancer. Having said that in the context of COVID-19 it is our experience and it's been well reported that if you already have a disease condition, which is causing inflammation on the lungs, and you acquire a COVID-19 or any other wider infection for that matter, your chances of getting more complicated is higher. And the recovery chances can be either prolonged or delayed or on the lore and compared to someone who has healthy lungs. So it's very important that these symptoms like chronic cough, shortness of breath, phlegm production, if they're as they have been there for a long time, that those not to be ignored because they can be a sign of some inflammatory condition in the lung, like COPD or asthma. And we want to make sure that we are taking care of those symptoms and doing our utmost to keep the inflammation down in the lung, that in case you end up acquiring any wider infection like in front or COVID-19, then you are at a position where you stand the best chance of fighting that infection at that point.

Host: Absolutely. And, you know, it's to the point that you brought up at the top of the episode around your lungs are the only organ that's exposed to the elements. And so it is extremely important to keep your lungs healthy and to keep them monitored, because when things like COVID-19 or any other infection comes along, the healthier your lungs are, the more likely it is that it doesn't affect you as seriously as it does people with these preexisting conditions. So I really want to thank you so much for your time. That's Dr. Faisal Khan, the medical director of the interventional pulmonary clinic at Franciscan Health at the Indianapolis campus. Thank you all for listening and for more information, visit Franciscanhealth.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk next time.