Transcription:
COPD, Symptoms, Causes and Treatments

Deborah Howell (Host): Hello and welcome to the show. You are listening to weekly dose of wellness brought to you by Memorial Care Health System, I am Deborah Howell and today’s guest is Dr. Robert Liou, a pulmonologist at Memorial Care Medical Groups primary care office in Bellflower Boulevard in Long Beach and he is here today to talk to us about COPD. Welcome, Dr. Liou.

Dr. Robert Liou (Guest): Thank you for inviting me.

Deborah: Pleasure to have you. Everyday, we see commercials on TV about medications for COPD, so sir what exactly is COPD?

Dr. Liou: Well, COPD is a chronic disease where its mostly caused by smoking and where your lungs become weaker and it creates an airflow obstruction, so basically what happens is the patients kind of really asthma like disease where they can't move air very well.

Deborah: And how serious is COPD?

Dr. Liou: It’s a very serious disease. Most patients with COPD, number one, they don’t realize that they have COPD and what you see is that they adjust their lifestyle to the point where they almost do nothing because they get so short of breath with walking.

Deborah: That must be very frustrating.

Dr. Liou: It is frustrating for the patients, but I think it's also very underdiagnosed disease out there because people don't tend to tell their doctors that they are just doing less and less and they are getting more short of breath doing so.

Deborah: So, they think maybe they're just getting older.

Dr. Liou: Part of it is that because a lot of the COPDers are actually smokers. They feel like it's probably just because the smoking is causing all that problem, but at the same time, they are having a hard time quitting smoking as they tend not to bring this up to doctors because of the social stigma associated with smoking.

Deborah: Okay, so what are some of the early signs and symptoms of COPD?

Dr. Liou: Most people will find that they have difficulty with exertion, so as they are climbing stairs, they get more winded and you know they just don’t do their housework as much because they get tired easily doing so and in some cases, they would actually have these wheezing which is the whispering sound when they get short of breath.

Deborah: I see, so that's in the beginning, but what are the long-term health effects?

Dr. Liou: The long-term health effects are actually quite severe. Patients with COPD can get so short of breath that they would require oxygen because they have such severe lung disease and some patients get so debilitated that they basically cannot walk anymore, that they would require scooters or electric wheelchair for mobility and they can hardly do any of their daily activity.

Deborah: Okay, that’s all the bad stuff, now let’s get into the good stuff. How is COPD treated these days?

Dr. Liou: So, the good news is there are lot of treatments out there and most of these treatments are with inhalers. It’s a disease very similar to asthma, so I try to explain it to my patients, well you kind of have a very asthma like disease except your lung damage is usually caused by smoking. COPD can actually also be caused from with burning stove and chemical inhalants as well, so the main treatment is medication called albuterol which is the same inhaler that the asthmatics use and this is an inhaler that opens up the lung, so that there is no obstruction and there are several other inhalers out there, there are short acting forms of it and long acting forms of it and then there are steroids that we could use to help the patient breath a little bit better just like asthma and recently there is actually a new pill out there that’s just a once daily pill that you can take to open up your lung.

Deborah: Really.

Dr. Liou: Yes.

Deborah: And what’s that pill.

Dr. Liou: That medication is called roflumilast which is still relatively new out in the market, but in the old days, we used to give theophylline for people with COPD, but that has a tremendous amount of side effects and its really hard to use and this is, I think it is a kind of a new and improved version of that.

Deborah: Interesting and so how should I expect to feel on this pill as opposed to taking nothing at all for COPD?

Dr. Liou: So, most patients feel a lot better in terms of their exercise capacity. They feel like they could do more with it. They get less short of breath. They feel like they can walk further with it and just the general sense of well being that is better with these inhalers.

Deborah: Okay, so an inhaler and a pill and then what should they know about side effects?

Dr. Liou: In terms of side effects, the main side effect that most people get with these short acting bronchodilators is that they get sometimes very jittering with it. The same receptor is also inside the heart that these medications act on and basically it can inadvertently make your heart rate go faster and so people feel little bit jittery while they are on the medication.

Deborah: Okay, you mentioned wood-burning stoves, could you elaborate on that a little bit because that’s a new thing.

Dr. Liou: Yeah, it is a new thing and I think COPD has traditionally carried a stigma because it’s predominantly smoking-related disease, so people tend to say, well you know, you did punish self because of the smoking, but more and more as we research into this disease, we are seeing a lot of third world country people who have never smoked, their predominate method of cooking is bio-fuel, so they use coal, wood and they actually get COPD from these smoke-related damage from these wood burning stoves with the bio-fuel, you know, it’s actually becoming quite a bit of problem in the third world country.

Deborah: Is there anyway to reverse the damage to your lungs once they are damaged?

Dr. Liou: So, currently we still don't have a good way to reverse damages inside the lung and that’s across all lung disease, so we can make the lung function a lot better with these medications that does not reverse the damage, in fact what we can work on with people who have significant debilitation from COPD is actually on the muscle what’s called pulmonary rehabilitation, basically you can't fix the damage that is done in the lungs already, so you are constantly having a lower supply of oxygen, but you can actually train your body to use oxygen more efficiently.

Deborah: I see. Is there any research going on about lung scarring and may be with stem cells?

Dr. Liou: Yeah, there is actually quite a bit of research going into it and part of it is because this new buzz of stem cell is one day going to fix everything. Unfortunately, the research with stem cell is quite complex because we haven't figured out how to make it do what we want to do. There is a research out there on stem cell for the treatment of COPD and unfortunately the results were not positive. There is not any significant difference in reversing the damage that is inside the lung with the stem cell. However, it is not to say that further research down the road will say otherwise, but with the technology we have right now with the stem cell, we are not quite there yet.

Deborah: So far we are not there, too bad, okay so let's get into the things that we can do to prevent COPD.

Dr. Liou: So, in terms of preventing COPD, avoiding smoking or any type of chemical irritants are very-very important. I think smoking is probably the number one cause of COPD, so you can also get this from secondhand smoke, so removing you from that environment or physically quit smoking yourself is the most important thing in terms of preventing COPD.

Deborah: Okay alright and then of course wood-burning fires.

Dr. Liou: Yes, that’s correct and for those people who actually have a profession that they deal with volatile chemicals that you could potentially inhale easily, observing occupational safety with respirators are absolute must and that goes with firefighters, painters, aerospace workers who actually work with volatile chemicals.

Deborah: Okay, so chemicals, wood-burning smoke, cigarette smoke, and hookah, does it cover all kinds of smoke.

Dr. Liou: We don't quite know exactly what is in the smoke that caused it, but it seems like if you use a cleaner bio-fuel that doesn’t create as much black soot then those patients tend to not get COPD when they have cleaner bio-fuel, so we think in terms of smoke, it’s probably related to the impurity that causes the soot and the smoke.

Deborah: This has been wildly-wildly interesting to me. I really appreciate you coming on this show. If our listeners want more information on chronic obstructive pulmonary disease, what should they do?

Dr. Liou: Well, the American Lung Association actually has a great website for educating the patients on COPD and I think that education is very-very important and inevitable part of patient’s care. The more they understand about the disease, the better that they can help themselves and I think the American Lung Association has a great website to actually educate the patient and that is just not on just COPD, but also on the other lung diseases such as asthma, pulmonary fibrosis, and all the other lung disease that you might hear of.

Deborah: I will go ahead and give that address, its www.lung.org

Dr. Liou: That’s correct.

Deborah: www.lung.org or the Center for disease control also has a wonderful website at www.CDC.gov. Thank you so-so much Dr. Liou for being on the show today.

Dr. Liou: Alright, thank you very much.

Deborah: To listen to the podcast and for more info, please visit memorialcare.org. I am Deborah Howell. Join us again next time as we explore another weekly dose of wellness brought to you by Memorial Care Health System. Have a fantastic day.