Scott Webb (Host): COPD is a progressive incurable lung disease, primarily caused by smoking that makes it difficult to breathe. And my guest today is here to tell us about COPD, who's at-risk, and how Salinas Valley Health can help. I'm joined today by Dr. Nicholas Klimberg. He's a critical care physician at Salinas Valley Health Medical Center.

 This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, it's great to have you here. We're going to talk about COPD and you're going to tell us what that is, of course, but symptoms, treatment, and hope related to COPD. So, let's start there. What is COPD and how does it affect the lungs and breathing?

Dr. Nicholas Klimberg: Chronic obstructive pulmonary disease or COPD is a blanket term. So, it describes lung conditions where the airways are swollen and narrow, and the air sacs are damaged. Other kind of terms people might have heard out there is chronic bronchitis or emphysema. These are both kind of one and the same. They both fall under the umbrella of COPD.

Depending on the severity of the damage, this can lead to difficulty breathing as well as problems with oxygen and carbon dioxide levels in the blood. Unfortunately, it can't be cured and it can get worse over time. But I think the good news is there's a number of strategies in medications that can really help people feel better.

Host: Yeah. And we're going to get to that for sure, because I wanted to just get a sense from you anyway, like what happens inside the lungs of someone who's living with COPD?

Dr. Nicholas Klimberg: To understand what happens inside the lungs, it's important to talk about, you know, how the normal lung works. So, in a broad sense, the lungs are designed to bring oxygen in from the outside, and then we eliminate carbon dioxide from the inside of our body.

So normally, the air that we breathe, you know, through our nose and mouth, travels very smoothly down our airways or the tubes of the lung. And this reaches kind of millions of tiny air sacs throughout our lungs. And each of these air sacs is surrounded by blood vessels. And so, the oxygen and the air that we breathe kind of passes, you know, into those air sacs, and it very quickly passes into those blood vessels.

 At the same time, that carbon dioxide kind of goes in the reverse direction. So, it leaves the bloodstream into the air sacs and is eliminated when we breathe. And in COPD, the problem is that, when we inhale certain damaging particles over a long period of time, this can damage the lungs in several ways.

So, one of the key things that happens is the airways of the lung kind of develop chronic inflammation, and this kind of leads to an excessive amount of phlegm production. And this inflammation can also cause narrowing of the airways, and that can make it difficult for air to move in and out. And at the same time, the air sacs are getting destroyed over time by these particles, and that can make it harder for that oxygen to get into our body and that carbon dioxide to leave the blood.

Host: Yeah. Yeah. I wanted to ask you the early signs and symptoms, it seems like maybe it's obvious that people have trouble breathing or shortness of breath, whatever it might be. But from you, the expert, like, anything we should be on the lookout for?

Dr. Nicholas Klimberg: Yeah, definitely. So, you know, in the early stages of COPD, there's oftentimes maybe no symptoms or only very mild symptoms. And sometimes people can kind of, you know, unintentionally chalk it up to, "Ah, I'm just getting older," or "I'm just, you know, not as fit as I used to be." But some of the classic symptoms in COPD, one of them is shortness of breath with activity, usually like everyday activities like walking down the street, carrying your groceries or doing housework. And classically, it will get worse over time.

Another pretty classic symptom associated with COPD is kind of the wheezing or whistling sounds when you breathe. This is not exclusive to COPD, but it is one of the kind of classic symptoms that we see; a lingering cough, where you frequently have to kind of clear a lot of phlegm from the lungs; and then, fatigue. These are pretty classic symptoms we see with COPD.

Host: Sure, of course. Yeah. Some of these things are also symptoms of other things, which is confusing obviously for patients and, hopefully, not providers, but maybe knowing our risk factors would help us to say, "Okay, this could be COPD," because I heard that great podcast and I have some of these risk factors. So, maybe you can give us a sense like who's at the highest risk for COPD?

Dr. Nicholas Klimberg: By far, you know, cigarette smoking is the leading cause of COPD in the United States. I would say it accounts for about 80% or more of people who have COPD. And of course, you know, the longer someone smokes, the more likely it is that they'll develop COPD.

Other risk factors that are important to be aware of, certainly secondhand smoke, so if you grew up in a household or a place of work that had a lot of cigarette smoke. And then, other things like dust, pollution, fume exposures, chemical exposures are all not nearly as common as cigarette smoking, but certainly contributors.

And then, I think, lastly, there's a small portion of patients who can have a rare genetic disorder called alpha-1 antitrypsin deficiency. So, this tends to run in families, and this can also cause COPD.

Host: Okay. Yeah. And you mentioned chemicals there. And that sort of sparked something, a light bulb went off, because I know we live in the salad bowl of the world, right, and a lot of ag workers. And I'm just wondering, do you see a lot of cases of ag workers being diagnosed with COPD possibly due to the chemicals they're exposed to?

Dr. Nicholas Klimberg: Yeah, definitely. We know that chronic exposure to things like organic dust, pesticides, fertilizers can definitely contribute to the development of COPD. It's certainly more common that our ag workers who have COPD will also have some cigarette smoking history. But we do believe that a lot of the occupational exposure is a big factor in their disease development.

Another thing I'll mention is we have many, many professions that support the agricultural industry as well. People like mechanics and people testing soils and all of those people as well can be exposed to various fumes and chemicals and organic dust, and those also increase the risk of COPD.

Host: Yeah, they could also be at risk. Let's talk about diagnosis of COPD. I'm assuming that early detection is key, especially for those at risk. You said there's no cure for COPD, but folks can live with COPD, so how do you diagnose it?

Dr. Nicholas Klimberg: Usually, we have, you know, a certain level of suspicion based on kind of those classic symptoms we talked about and the risk factors. And so, when people have that, the kind of gold standard test is something called a pulmonary function test or spirometry. This is a breathing test. So basically, we have a measuring device And we make a patient breathe in and out. And then, we make them breathe really rapidly, and see how much air can they actually expel out of their lungs. In patients with COPD, because of the narrowing of the airways and the loss of those air sacs, they have a lot of trouble blowing the air out of their lungs. So, that shows up on our testing. And so, when we see that on our testing, that essentially confirms the diagnosis of COPD.

Host: Okay. Yeah. And we touched on that there really is no cure, not yet anyway. But perhaps, you know, medicine, science moving so rapidly. But for today, how do you treat COPD? How can folks live with it?

Dr. Nicholas Klimberg: I think the key thing to understand is, you know, even though there is no cure, there are a number of therapies nowadays that can help manage symptoms and kind of prevent progression. So, two of the most common medications for COPD is bronchodilators and glucocorticoids.

So, bronchodilators are these inhaled medications and they work primarily by opening up those airways, those tubes of the lung. And so, this allows for that air to kind of move in and out of the lungs, you know, much more easily. And they also work by kind of reducing some of that phlegm in the lungs that people are producing. The glucocorticoids, commonly people will just know them as steroids. They are really important because they work by reducing the amount of inflammation in the lungs. And these can be inhaled for long-term reduction of inflammation, or they can be taken in pill or IV form for a short time if a person with COPD is having a flareup of those symptoms or what we call an exacerbation.

And for patients who don't respond to these kind of common medications, there are a number of other medications available in various forms, pill form, injection form, other inhaled forms, that can also help kind of control COPD.

Host: Yeah, the interesting word choice there, right? So, we're sort of controlling COPD, hoping that folks can live with it, and enjoy their lives, of course. Let's talk about lifestyle changes. It sounds to me like, well, quit smoking, right? There's so some obvious things we can do. But just in general, what could folks do to help themselves to manage COPD and, I don't know, slow the progression?

Dr. Nicholas Klimberg: Yeah, I think, you kind of touched on the most important change, which is to quit smoking. Smoking is the direct cause of COPD. So, the sooner someone quits smoking, the slower their disease will progress. And we obviously understand that, you know, quitting can be really difficult. And so, I encourage anyone struggling to quit, or anyone interested in quitting to talk with their healthcare provider, because there are a lot of strategies nowadays and medications to help people quit.

Other than quitting, you know, cigarettes, staying active is really important. The more you move, the better your heart and muscles use the oxygen that you give it. And the less we need to really rely on our lungs. And of course, physical activity is really helpful for preventing other chronic illnesses that can kind of be a burden on our lungs.

Other important factors, nutrition. Eating well really helps COPD patients maintain the energy that they need. So with COPD, there's a lot of extra breathing. And so, extra breathing leads to kind of increase energy requirements. So, we encourage everyone with COPD to try to maintain a healthy diet.

And lastly, you know, we do obviously have people who struggle with being overweight or obese. And so, that can also worsen symptoms of COPD. So, anyone who's overweight or obese, it would be very helpful to lose. Even a small amount of weight can help reduce symptoms a lot.

Host: Doctor, this has been great today. It's always good to learn from experts. That's why we ask the experts and hopefully they have the answers, and you did. So just to wrap up, like, what advice would you give to someone who's been newly diagnosed with COPD?

Dr. Nicholas Klimberg: You know, if you've been newly diagnosed with COPD, it can be very scary and it's important to understand, you know, it's not a death sentence. Many treatments are available nowadays. Every year, it seems like there's a new treatment. So, we can often help many of our COPD patients, even in those with very severe symptoms, continue to live a full and active life. And so, I encourage everyone who's been diagnosed to talk with their doctors to learn more about COPD and to understand kind of the options available to them to get treatment.

Host: Yeah, that's great advice, right? If you know you have the risk factors. If you happen to be a smoker, if there's things that lead you to believe that the signs or symptoms you're experiencing might be COPD, reach out, speak with your provider, perhaps get referrals if needed. I appreciate your time. Thanks so much.

Dr. Nicholas Klimberg: Yeah. Thank you.

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.