Jaime Lewis (Host): Breathing is not something many of us think about, until we can't easily breathe. Joining us today is Matthew Varner, a Pulmonary and Critical Care Medicine physician with Prisma Health Pulmonology to discuss chronic obstructive pulmonary disease, better known as COPD. According to the National Institutes of Health, more than 15 million adults in the U.S. have COPD, and many more don't even know they have it.

This is Flourish, a podcast from Prisma Health. I'm Jamie Lewis. Dr. Varner, hello.

Matthew Varner, DO: Hey, how are you?

Host: I'm great.

Matthew Varner, DO: Thanks for having me.

Host: Yes, of course. Let's start at the beginning. What is COPD and what causes it?

Matthew Varner, DO: COPD stands for chronic obstructive pulmonary disease. And the only way to confirm diagnosis of COPD is by pulmonary function tests, which your pulmonologist or some other physicians can perform. We call them breathing tests where you sit in a booth, and we do some breathing maneuvers to see if you have obstruction. The two main conditions that contribute to COPD are chronic bronchitis and emphysema.

Chronic bronchitis involves the inflammation and narrowing of the airway tubes, which carry the air to and from the lungs. And the inflammation then leads to increased mucus production and further causing airflow obstruction. And then, emphysema is actually the tissue destruction of your lungs that damages the air sacs or the alveoli, reducing their elasticity and making it difficult for them to expand and contract properly during breathing. And then, this results in decreased oxygen exchange in your lungs.

The primary cause of COPD is long-term exposure to irritants that damage the lungs and airways. The most common irritant is cigarette smoke, but there are other factors such as exposure to secondhand smoke, air pollution, chemical fumes, dust, and genetic factors that can also contribute to the development of COPD.

Host: You pretty much answered part of my next question. Do only smokers get COPD? But it sounds like possibly not. Who is most at risk?

Matthew Varner, DO: So as we kind of discussed, smokers are not the only people who get COPD. While smoking is the leading cause of COPD, non-smokers can also develop the condition due to exposure to other lung irritants. Individuals that are most at risk, as previously said, are current or former smokers, as that's the primary risk factor for COPD. The longer and more heavily someone smokes, the greater the risk of developing the disease. People with long-term exposures to lung irritants, which could be secondhand smoke or occupational dust such as coal dust, silica or asbestos, even air pollution, chemical fumes and indoor biomass fuel use, which is individuals who are using wood or coal for cooking and heating indoors.

And then, there's also people that have genetic predispositions to developing COPD, even with relatively low levels of exposure to lung irritants, and then individuals that have what's called alpha-1 antitrypsin deficiency, which is a genetic condition that affects the production of a protein that helps protect the lungs. Individuals with this deficiency are at higher risk for developing cOPD, especially if they do smoke. But overall, anyone exposed to lung irritants over an extended period of time is at risk for developing COPD. But certain factors such as smoking and genetic predisposition certainly increase that risk.

Host: What are some signs that a person might have COPD?

Matthew Varner, DO: So, the hallmark symptom that we see with patients with COPD is shortness of breath, or what we also call as dyspnea. Essentially, that patient will get initially short of breath with physical exertion, but then can progress to being short of breath even at rest as the disease advances. Patients can also have a chronic cough, a persistent cough that produces mucus. It's a common symptom, usually worse in the morning, and then also if they have a respiratory infection. They can have wheezing or this whistling or squeaky sound when they're breathing in and out, particularly when they're exhaling. That can indicate some airway obstruction. They also can have some chest tightness, which is like a sensation of this pressure or tightness where you can't really take a deep breath in or out, which results in some difficulty breathing. Patients can have frequent respiratory infections. And COPD can weaken the immune system and make individuals more susceptible to respiratory infections such as cold, flu, pneumonia. They can have some lack of energy, because COPD can cause some fatigue and general feeling of low energy due to the extra effort of requiring them to breathe. And then, they also can have some unintentional weight loss as COPD. Mainly severe COPD can cause a decreased appetite and weight loss, which can be unintentional.

Host: I know diseases like this often affect women differently than men, men differently from women. Is that the case with COPD?

Matthew Varner, DO: Yeah, it can affect women differently than men in terms of the symptom presentation, disease progression, treatment response. Women may be more susceptible to the harmful effects of cigarette smoke and may experience more severe symptoms at a younger age compared to men.

Host: Okay. So, can COPD be cured? How is it treated?

Matthew Varner, DO: Unfortunately, COPD cannot be cured, but its progression can be slowed and symptoms can be managed through various treatments. The goals of COPD treatment are to relieve the symptoms, improve quality of life, and reduce the frequency and severity of exacerbations or flareups. We have a variety of treatment options now, majority involve inhaled medications. The ones we usually use are what's called beta-agonists. We have beta receptors in our airways and these medications hit those receptors and helps the muscles relax around the airways and make it easier to breathe. There are short-acting versions such as albuterol, which many people know about, and there's also long-acting versions. We also have inhaled corticosteroids. These medications help reduce airway inflammation. And then, we also have what's called inhaled muscarinic antagonists. These are receptors in our airways that these medications help relax the muscles and around the airways leading to bronchodilation or widening the airways and improve airflow. And we usually use those in combinations, those three.

Additionally, we have monoclonal antibody biologic therapies for patients that have what we call type 2 inflammation. These are injections, and they basically work on immune cells that are known to cause inflammation and, basically, prevent their activation for causing inflammation. And we also have medication called a phosphodiesterase-4 inhibitors, which can help reduce inflammation and relax the airways. This is usually used in severe COPD patients.

One of the hallmarks of patients with severe COPD is pulmonary rehab, which is exercise, training, education, and support to help individuals with COPD to improve their exercise tolerance, learn breathing techniques, and manage their symptoms more effectively.

Another therapy that I perform personally is a bronchoscopic volume lung reduction, which is a minimal invasive procedure used in the treatment of COPD with severe emphysema. And this procedure aims to reduce the hyperinflation and improve lung function by reducing the volume of the diseased lung tissue, and therefore, allowing healthier lung tissue to function more effectively. Essentially, the procedure is placing one-way valves in the airways leading to the diseased lung region. These valves allow air and mucus to exit the affected area during exhalation, but prevent them from reentering during inhalation, effectively blocking airflow to the diseased lung region.

Additionally, patients may require oxygen therapy to maintain a certain oxygen saturation level to improve oxygenation and reduce symptoms such as shortness of breath. We advise our patients with COPD to have their annual flu vaccines and pneumococcal vaccines to help reduce the risk of respiratory infections that can worsen symptoms and lead to exacerbations.

And of course, we would ideally like patients to stop smoking, as that's essential to slow the progression of the disease and reduce symptoms. And then, lifestyle modifications such as maintaining a healthy lifestyle, regular exercise, balanced diet, and avoiding exposure to lung irritants are all ways we can help.

Host: And how can a patient improve the air quality of their home?

Matthew Varner, DO: Yes. Air purifiers can be beneficial for patients with COPD by helping to remove any of those irritants, the airborne particles, pollutants, allergens from indoor air. You can get HEPA filters, or air purifiers with a high efficiency, particle air filters, activated carbon filters. And then, you also improve the ventilation in your house, making sure there's proper ventilation in your home by opening windows and doors to allow fresh air to circulate, use exhaust fans in the kitchens and bathrooms to remove moisture and pollutants from indoor air, control the humidity, maintain indoor humidity levels between 30% and 50% to prevent mold growth and reduce the proliferation of dust mites, as well as reduce sources of indoor pollution. Minimize indoor air pollutants by avoiding smoking indoors, using household products, and cleaning chemicals with low VOC emissions. And proper ventilating gas appliances and wood burning stoves, as well as regular cleaning, vacuuming, dusting your home to remove any pet dander, dust, other allergens from surface and carpets.

Host: Can changes in the weather aggravate COPD?

Matthew Varner, DO: Yes. People with COPD may be sensitive to changes in temperature, humidity, air pressure, and air quality. Cold air can irritate the airways and cause bronchospasm, which is essentially the constriction of the airways, leading to increased shortness of breath and coughing. Humidity, high humidity levels can make it hard for individuals with COPD to breathe, as humid air can feel heavy and cause mucus to become thicker and more difficult to clear from airways. Air pollution, changes in weather patterns such as temperature, inversion of static air masses can lead to increased levels of air pollution, leading to particular matter, ozone and other pollutants. Allergens, pollen, mold spores, dust mites can affect individuals.

Host: Thinking about patients who may want to exercise. Is that something that anyone with COPD can still do?

Matthew Varner, DO: Yes, definitely. We encourage exercise as it's highly beneficial for patients with COPD. Although it may seem counterintuitive to engage in physical activity when breathing is already a difficult rigor, exercise can actually improve lung function, strengthen the respiratory muscles, increase endurance, and enhance overall quality of life.

Host: Now socially, is there a stigma that people with COPD are to blame for their condition, for being smokers or what have you? And what can be done to overcome that?

Matthew Varner, DO: Unfortunately, there is a stigma that patients who have COPD, they did it to themselves by smoking. But as we discussed earlier, not all patients with COPD smoke. To overcome the stigma, essentially to raise awareness and educate the public about the multifactorial nature of disease and that there are various factors that can contribute to its development. Some ways we can do that is by educating about the causes. Increased awareness of the diverse causes of COPD go beyond smoking and there's genetic predisposition to it, occupational exposure, air pollution, and some other factors. Also, highlight the complexity of individuals that do smoke and that nicotine is highly addictive, and it's hard to quit smoking, even if the individual is trying, so we can provide support and resources for smoking cessation to patients who wish to quit.

 And additionally, promoting empathy and understanding with patients living with COPD and that they're not to blame for their condition and recognizing that the challenges they face and validate their experiences and emotions and efforts to maintain their health.

Host: This has been so informative. Thank you, Dr. Varner, for joining us.

Matthew Varner, DO: Thanks so much. I appreciate it.

Host: I'm Jamie Lewis. And for more information on COPD or to hear other episodes from the Flourish Podcast from Prisma Health, please visit prismahealth.org/flourish.