Transcription:

Joey Wahler (Host): COPD and emphysema are diseases that impact the lungs and early detection is key. So, we're discussing how to know if you may have lung disease and, if so, how that's addressed.

This is Right Beside You, a Reid Health podcast. Thanks for listening. I'm Joey Wahler. Our guest, Dr. Anthony Vacca, a pulmonologist at Reid Health. Dr. Vacca, thanks for joining us.

Dr. Anthony Vacca: It's my pleasure.

Joey Wahler (Host): Same here. So how prominent are lung disease and lung cancer in our community?

Dr. Anthony Vacca: I think lung disease is very prevalent in the entire world. I don't think it really matters where we are so much as age and your exposures and lifestyle. So to answer your question more succinctly, it's prevalent. It's one of the most prevalent diseases found.

Joey Wahler (Host): And it's a misconception that lung issues happen only to tobacco users, right?

Dr. Anthony Vacca: That's correct. There are many things that can cause lung disease. Environment, tobacco is one of those; your occupation, sometimes there are occupational exposures that can cause lung disease. Sometimes it's genetic. Sometimes it's just contagious as an infectious or inflammatory disease. So there's many factors that contribute to lungs, not just smoking.

Joey Wahler (Host): So what symptoms typically, be they chronic or otherwise, respiratory or otherwise, would bring a patient to you in the first place?

Dr. Anthony Vacca: Sure. The most common symptom is shortness of breath, but we define shortness of breath as a couple of different factors. So the shortness of breath at rest or waking you from sleep is different than what we call dyspnea, which is shortness of breath of exertion. I think those two symptoms are the most common. But also we think about orthopnea, which is getting short of breath if you lay down flat, cough, sputum production. Loud snoring and apnea are actually signs of a different type of lung disease called sleep apnea; hypersomnolence, being tired all day long.

Very commonly, chest pain, most people think about the heart. But I believe the lungs are probably just as common to cause chest pain as the heart is, if not more. So sometimes people like to, or rather not like too, but they think that a chest discomfort might be a heart problem when really, you're overlooking a pneumonia or a disease that causes pleurisy, which is an inflammation of the lining of the lungs. Those are the basic symptoms that we look for, but there are many others.

Joey Wahler (Host): So the things you mentioned are all those that if ignored for a time can obviously greatly impact someone's quality of life, right?

Dr. Anthony Vacca: Of course, chronic chest pain, chronic shortness of breath puts a strain on your day-to-day lifestyle, causes difficulty in what we call performing the activities of daily living, just climbing a flight of steps or carrying groceries in. Sometimes people, they're more sedentary and they don't realize that they have lung dysfunction simply because they don't put their lungs or heart at strain. And then they exercise a little bit, as I said, carrying groceries into the store or climbing a flight of steps or running the vacuum sweeper. And then they realize that they're getting symptoms of shortness of breath and dyspnea, when those symptoms may have been there for a long time, but because of the sedentary lifestyle, they don't think about it.

Joey Wahler (Host): Interesting. So what are the lung diseases most commonly treated?

Dr. Anthony Vacca: That's a difficult question, because there are many lung diseases. But the most common, I guess, would be what we call chronic obstructive pulmonary disease. And I'd like to just take a moment to explain COPD as most people call it. I don't want to say it's a disease, but it's more a spectrum of diseases. And the most common question I have is people will say to me, "What's the difference between emphysema and COPD?" or "Doctor told me I had emphysema, but another doctor told me I had COPD." Well, the difference is that COPD as a spectrum includes emphysema at one end of the spectrum, but also includes chronic bronchitis or chronic asthmatic bronchitis, bronchiectasis at the other end of the spectrum. So, most people who have COPD are dealing with emphysematous lung disease and chronic bronchitis, but just at different levels for that individual person.

Other disease processes you're talking about are asthma, sleep apnea, many other disease processes such as rheumatoid arthritis and the rheumatoid diseases cause lung dysfunction. There's also lung cancer. But the lungs, because they're a filter of the body, also can have secondary cancers in them, such as prostate or breast or bone cancer. What else? So there are people who have other occupational exposure, such as coal miners or farmers or people who work in garment factories, where there's exposure to lint. So a lot of diseases are caused by inhalation of toxic chemicals or fumes or particles. So all these different entities are common in this area and are probably the most common diseases that I see in my office.

Joey Wahler (Host): So because you do see a lot of COPD, as you mentioned, what are the causes and symptoms of that?

Dr. Anthony Vacca: That's a good question. We all know the most common cause of COPD is going to be tobacco, whether it's a first-hand smoker or a secondhand smoker. But there are many other causes of COPD besides smoking. So just because you're not a smoker, doesn't mean you can't get COPD.

In my office, we test for a disease called alpha-1 antitrypsin. It sounds complicated, but it's not. The body makes chemicals that clean the lungs. People who have a genetic predisposition that do not clean their lungs can develop very severe emphysema very early in life, much more severe if they smoke. But even if they don't smoke, they can develop this disease, just because it was passed on to them by genetics. And just because your parents didn't have the disease, doesn't mean you can't get it because it's a complicated process, but it's called a recessive gene. So your parents both carry it, but don't have it. You can develop the disease. You don't realize you have it until it's late. So most people who are tested for COPD in my office are also tested for this disease process. I think exposures to certain chemicals or certain lifestyles can also cause COPD and aging causes COPD.

Joey Wahler (Host): And how is it usually treated?

Dr. Anthony Vacca: The initial treatment would be to avoid whatever it is, if you can, that's causing the problem. So smoking cessation is the most important treatment factor or exposure to other things that maybe if you work where there's a lot of inhaled smoke, you want to avoid those things.

Other treatments would include multiple breathing medications that can treat COPD depending on whether it's emphysema or whether it's asthmatic bronchitis. And then of course, there's all sorts of physical therapy and breathing techniques that help people to do better with their breathing. You sort of have to make people that have COPD understand that their heart and lungs also contribute to their shortness of breath. So even though you have COPD or emphysema, you can make your heart and lung stronger with physical therapy or pulmonary rehab and that helps with your breathing as well.

And then finally, if the COPD is bad enough, then people can develop what we call chronic respiratory failure, which means that they're going to wind up needing oxygen or some help sleeping to help them get rid of their carbon dioxide because the lungs aren't working. So the final treatments would be maybe a BiPAP machine or a CPAP machine, which is a pressure machine, it helps you sleep at night and helps you get rid of the carbon dioxide or supplemental oxygen if needed.

And of course, we always want to get people into pulmonary rehab, as I said. And if it's bad enough, you get your handicap stickers and things like that, to make it easier for you to perform your ADLs or activities of daily living.

Joey Wahler (Host): And then how much does COPD increase someone's risk of lung cancer and do lung cancer symptoms differ from those of COPD?

Dr. Anthony Vacca: Yeah, that's another good question. And I don't think that COPD contributes to lung cancer, unless the cause of the COPD is the tobacco use or an inhaled irritant. So, we always look for lung cancer or we always screen for lung cancer is a better way to put it in people who have significant COPD if they're smokers, but they don't necessarily run hand in hand. Well, certainly if someone's smoked a pack of cigarettes a day for 50 years and they have COPD, then we're looking for the lung cancer to make sure it's not there.

Just an added tidbit is that we do lung screening after the age of 45 for people who have had any significant smoking or secondhand smoke, primary or secondary hand smoke. To answer your other question, the symptoms can or cannot be similar. People who have lung cancer, unfortunately, usually don't develop symptoms of the lung cancer until the lung cancer is quite advanced. So those symptoms would include pleuritic chest pain. Pleuritic chest pain is a sharp, stabbing pain that you might get in the middle of your chest or in the side of your chest when you take a deep breath or if you cough. You can also see hemoptysis that usually happens when the lung cancer has become large enough to actually have its own blood vessels. And then, it can bleed into the breathing tubes and you cough that out and you see it. Weight loss, anorexia, loss of appetite, lack of energy, things like that.

Joey Wahler (Host): Well, you mentioned some things there that I'm hoping you can follow up on. For instance, you mentioned the importance of early detection and you mentioned lung screening starting in your 40s. What's involved in that and how long does it take to get a result?

Dr. Anthony Vacca: Well, usually, if we see someone who is a smoker, that's over the 45th year and they've smoked for more than five to ten years, we offer a low-density screening CAT scan to look for lung cancer. So it's really less radiation and it can be done very quickly. It only takes about 15 minutes and the results are usually back in about 24 hours. So what we're looking for there are small, we call it nodular disease or nodules that might be indicative of an early cancer. Once we find a nodule, then depending on its size, we can either follow it to make sure that it's not growing or, if it's big enough, we go further with testing to make sure that it's not a lung malignancy. And just to put people at rest or in their mind, most lung nodules are not malignant, but we'd like to catch the ones that are, so we can treat this to cure rather than have to start with other more aggressive things like chemotherapy.

Joey Wahler (Host): Now, Reid Pulmonology has more than 60 years of experience in this field with multiple outreach locations as well. So from your experience, how does that translate to helping patients better?

Dr. Anthony Vacca: Well, I myself have 30 years of individual practice in pulmonary medicine. My partner and nurse practitioner also have a very high level of experience. And when you're experienced, it helps you to take each patient individually and see them as an individual, because although they can have the same diagnosis as the person right next to them, their symptoms may be very different.

So, you know, medicine is not just science, it's an art. And that art is to take the individual and see them for who they are and then determine exactly what their disease process is and what the best treatment for them might be as opposed to the person sitting right next to them. So when you have experience for the many years that we have, it helps you to do that more effectively, I think, and not miss subtle hints that might help you find out what's going on with your patient.

Joey Wahler (Host): Sure. So experience certainly counts. And then finally, someone can be self-referred to Reid Pulmonology. What does that mean?

Dr. Anthony Vacca: Well, usually, a subspecialty like a pulmonologist or a cardiologist or gastroenterologist has to have a referral from a primary care provider. But at Reid, we think that sometimes we don't want to waste the time in waiting for the referral to come through. And if a patient is concerned about anything at all that might have to do with their lungs, they can call our hotline and make an appointment on their own simply by explaining what their problem is, what they want to be seen for, and we'll get them in to be seen by one of our providers.

Joey Wahler (Host): Sounds great. Well, folks, we trust you're now better versed in how lung disease is diagnosed and treated. Dr. Anthony vacca, Thanks so much again.

Dr. Anthony Vacca: It's been my pleasure. Thank you very much.

Joey Wahler (Host): Same here. To make an appointment at Reid Pulmonary Care, please call 765-935-8943. Again, 765-935-8943. For more information, visit reidhealth.org. Again, reidhealth.org. If you found this podcast helpful, please share it on your social media. And thanks again for listening to Right Beside You, a Reid Health podcast. Hoping your health is good health, I'm Joey Wahler.