Joey Wahler (Host): It can hurt breathing ability and diminish someone's lifestyles. We're discussing chronic obstructive pulmonary disease, also known as COPD. Our guest is Robert Fishwick. He's manager of respiratory care and pulmonary diagnostics for St. Joseph Hospital.

This is Wellness First, a St. Joseph Hospital podcast where we hear and learn directly from the experts on all things health and wellness. Thanks so much for joining us. I'm Joey Wahler. Hi there, Robert. Welcome.

Robert Fishwick, MSHCM: Good morning. Welcome.

Host: Great to have you aboard. So first, for those that aren't completely familiar, what exactly in a nutshell is COPD and how does it affect the respiratory system?

Robert Fishwick, MSHCM: That's a great question. COPD or chronic obstructive pulmonary disease comprises mainly two to three different diseases. There is chronic obstructive bronchitis or chronic bronchitis and emphysema. There's also kind of a third disease, what we call asthma-COPD overlap syndrome. So, we have those patients that may have those asthma-type picture, but also has that kind of persistent obstructive airways disease. What happens with these patients is they develop kind of this breathlessness that worsens over time. And that breathless really starts to affect a patient's everyday lifestyle and eventually, down the road, their quality of life.

Host: So when we talk about these symptoms reducing quality of life, what are we talking about? We're talking about fatigue and some other things, right?

Robert Fishwick, MSHCM: There is a myriad of symptoms that are associated with COPD. So if you think about chronic obstructive pulmonary disease, think about somebody that they're trying to walk and, as they're trying to walk, their breathlessness just becomes worse, or they notice going up a flight of stairs, they just become more shorter breath. They may, to your point, experience more fatigue. They may start to experience a decrease in exercise tolerance. They may start to experience that their activities of daily living, all those everyday things that they do, such as bathing and getting dressed and going to the grocery store, that they start seeing limitations to those everyday abilities because the disease is creating that worsening perceived shortness of breath with our patients.

Host: I would imagine for people experiencing this for the first time, it's got to be scary, right? Because you're suddenly not able to breathe in a normal way. Something I would imagine people take for granted until it's not what it normally is, right?

Robert Fishwick, MSHCM: That's absolutely 100% true. I think we find that, with most of our patients, they may notice sudden little changes. And sometimes people say, "Well, I'm just getting older," or "I've put on some extra weight," or "I'm not exercising like I used to," when in fact, what's happening is that there's actually a worsening down in their small airways, and there's becoming more of this obstructive pattern. So, the air comes in, but they have difficulty getting the air out. And a lot of times, people will brush it off until the point where they really say, "Wow, I really become more short of breath with these activities. And that's usually the time that they may seek out and start asking questions to their providers about that.

Host: So, what are the primary causes and risk factors associated with developing COPD? Naturally, smoking tops the list, right?

Robert Fishwick, MSHCM: Smoking is one of the number one causes of chronic obstructive pulmonary disease, not only in the United States, but definitely in the world. But we also see that there are, you know, inhaling any type of noxious or toxic fumes. So, any type of environmental or occupational-related hazards may also relate to later development of chronic obstructive pulmonary disease. But definitely, like you mentioned, smoking is one of the number one causes.

Host: So, what other causes are there and can you get it even if you've not smoked?

Robert Fishwick, MSHCM: That is an excellent question. So, A, can you get it if you haven't smoked? Yes. So, believe it or not, there are instances where people develop chronic obstructive pulmonary disease, secondary to secondhand smoke exposure, for example. There are certain types of industries, let's say, welding, for example, where there is gas off, or certain types of jobs where there's a lot of gaseous types, or noxious inhalation of certain types of chemicals that can be inhaled that cause COPD.

There's also hereditary disorders. For example, not everybody that smokes or has these secondary issues developed COPD. So, alpha-1 antitrypsin deficiency, for example, you never smoked in your life, have no inhalation of any type of occupation or hazardous materials, and some people just lack this alpha-1 antitrypsin enzyme, this defect, and that will result in people developing COPD.

Host: So, that makes me think of this question. Let's say you know there to have been a history of this in your direct family. If you have one of those jobs that you mentioned where you could be more at risk, even if you don't have that history, it might be a good idea to go get checked out before the fact to make it preventative?

Robert Fishwick, MSHCM: Absolutely. So, I think first and foremost, smoking cessation is very, very important. And we know that it's not easy for patients, or anybody, to stop smoking, but there are smoking cessation programs. We want patients to go out there. We encourage them to enroll. We encourage them to take steps to quit smoking, to start to minimize those potential hazards.

Definitely, if you're experiencing any type of breathlessness that hasn't previously been present, I think it's important that you ask your provider and have conversations with your provider to see if there are testing that we can do to take to see why this breathlessness is occurring.

Host: How about people that have been relatively heavy smokers that have quit for a while, maybe even for decades, they can still get this, right?

Robert Fishwick, MSHCM: That's absolutely correct. If there's one thing I can say about COPD is it's a very insidious disease. And what do I mean by that? To your point, somebody may have smoked years and years and years ago and they may come and they say, "Well, I haven't smoked in 20 years, but I'm experiencing this sudden change in in my breathlessness." And absolutely, those patients can still develop COPD, even though they may have stopped smoking 20 years ago, because the changes that occur in our small airways 20 years ago are just going to simply continue to progress, even though we've stopped smoking. So again, my point is, should we work on smoking cessation to minimize the risks of developing COPD? Absolutely. But to your point, a person can have quit X number of years ago and start experiencing this symptomatology later on in life, and it definitely, again, is a question that should be brought up to your provider to investigate further.

Host: So, if it's suspected that COPD could be on hand, how do you go about diagnosing it?

Robert Fishwick, MSHCM: Number one, to my point, it starts with having a conversation with your provider. And I think patients should not be afraid to ever broach any question with their provider or to talk about any new onset of symptoms that they're having. What we generally do is, you know, you may need to go see a pulmonologist. That's definitely a possibility. But one of the first steps we can do is we can bring you into the pulmonary function lab. And we can do specific testing that looks at your small airways, for example, and how gas passes in and out of your lungs. And that will help us to start down the road of making a diagnosis.

Host: So, what treatment options are available, and I might be getting ahead of things a little bit but in conjunction with that, this can't be cured, am I right? Just managed and maybe kept under wraps, yes?

Robert Fishwick, MSHCM: That's correct. There is no cure for chronic obstructive pulmonary disease. So, there's no cure for chronic bronchitis. There's no cure for emphysema. It is about symptom management. The disease will progress, the question is always, that we don't always know the answers to, is how fast will the disease progress. But again, if you're diagnosed with COPD and you continue to smoke, for example, is it going to probably likely make your disease progress at a faster rate versus smoking cessation? Absolutely.

So, treatment options generally can revolve around things such as inhaled medications. So, we want inhaled medications to control the symptoms, right? So, we want to minimize exacerbations. We want to minimize patients having these sudden acute attacks that land them in the emergency room or land them sitting with us in the hospital. We want patients to be at home.

Exercise, light to moderate exercise is very important. I highly promote pulmonary rehabilitation as a great way for our patients with chronic obstructive lung disease to learn the importance of light to moderate exercise, learn about conservation techniques with energy conservation, breathing techniques, learning about the importance of how to use your medications, learning the importance of diet, just as examples to help patients with better quality of life. And that's really what it's about. We want our patients with lung disease to live fruitful lives. We want them to stay in our community and we want them to have good quality of life.

Host: And you actually partially answered what was going to be my next question there about lifestyle adjustment. It sounds there like you're saying in a nutshell that people with this condition, COPD, just have to accept that things have changed for you and you need to adapt in order to still make the most out of the life that you have, right?

Robert Fishwick, MSHCM: I would agree. I think that with any time we live with chronic disease, there needs to be a level of acceptance. And with that acceptance comes with what steps can we take together as a healthcare community. So, for example, you know, at St. Joseph's, we promote health and healthcare. We have a multidisciplinary team that is here to be collaborative for our patients so that they don't ever feel alone. It's very common for our patients with COPD to feel like they're alone. Many of them live in our community. Sometimes they have good family support network. Sometimes they don't have good family support network. Having programs, for example, like pulmonary rehab, brings like patients together. So again, they learn all those lifestyle parts of living with chronic lung disease.

And the benefits of those programs is people in pulmonary rehab build relationships together, right? They learn that they're not alone. They learn that there are other people who are living with this disease. There's a very large support mechanism in place because we want our patients to stay in the community. We want them to have a great quality of life. And we want to be here to support them living with chronic pulmonary conditions.

Host: So in summary, it sounds certainly like you're saying that this doesn't need to be something that you go through alone, that there are professionals like yourself, you and yours. There are others going through something similar, there's family, friends, et cetera. And with the right support, people should not look at this as something that's necessarily going to adversely affect their life if they can, as you put it, accept it and adjust, right?

Robert Fishwick, MSHCM: That's correct. There are millions of people in the United States that live with chronic obstructive pulmonary disease, and these people live very fruitful lives. They live high quality lives. They're active in their community. They're active with their friends. Yes, it can be a very difficult disease to live with.

Yes, it can cause breathlessness. But to your point, we want to ensure that our community members understand that they're not alone in this, that there is an entire network, an entire team that is here to help them and support them and help them to live a better quality of life with COPD.

Host: Indeed. Well, folks, we trust you're now more familiar with COPD. Robert Fischwick, thanks so much again.

Robert Fishwick, MSHCM: Great. Thank you very much.

Host: And for more information, please do visit stjosephhospital.com/services/pulmonary-medicine. If you found this podcast helpful, please share it on your social media. I'm Joey Wahler. And thanks again for being a part of Wellness First, a St. Joseph Hospital podcast.