Scott Webb (Host): Today, I'm going to discuss COPD triggers and how we can avoid them with Dr. Van Kim Holden. She's an interventional pulmonologist at UM Capital Region Health.

Welcome to the Live Greater podcast series, information for a healthier you, from the University of Maryland Medical System. I'm Scott Webb. Doctor, thanks for joining me.

Van Holden, MD: Hi. It's a pleasure to be here.

Host: Yeah, it's nice to have you here. We've spoken before about COPD, but we're going to do it again today. So, let's just start there. What is COPD?

Van Holden, MD: Good question. So, that's a very important question as well so that patients understand exactly what they have. So, COPD stands for chronic obstructive pulmonary disease. And so as the name implies, it's chronic and that means that there's actually no cure for COPD, but it can be manageable. And it is a pulmonary disease or lung disease. And then, the word obstruction refers to what is the problem with the lungs. And so most of the time, COPD is caused by cigarette smoking. And the cigarette smoking causes damage to the airways. This damage can make the airways thickened and very inflamed. And then, that can lead to a lot of mucus production. So, this is referred to as chronic bronchitis where patients may be coughing up phlegm every day.

The other problem with obstruction is that it can also lead to damage of the small airways, making it hard to breathe. So, patients may feel like it's harder to get their breath out. And this is referred to as emphysema. So, chronic bronchitis and emphysema are both types of COPD. Sometimes the terms can be a little bit confusing. So, COPD is a chronic obstructive lung disease.

Host: So, let's talk about triggers. How do triggers work? Does it trip up breathing or cause symptoms to flare up?

Van Holden, MD: Yeah. So, a trigger is anything that can make the COPD worse acutely, meaning all of a sudden. And the most common trigger for COPD exacerbation is a respiratory infection. So, getting any sort of viral infection, a cold, the flu, COVID, RSV nowadays, these respiratory infections can make the COPD worse. Anything that makes the COPD worse is called a trigger. And when a COPD gets worse, it often manifests as having a harder time breathing, coughing up even more phlegm, or the color of the phlegm changes. And so, knowing what triggers your worsening breathing or coughing is important, because then you can work on avoiding those triggers. And you can work with your healthcare professional to sort of identify what are your individual triggers. It's different for everybody.

Host: Right. Different for everybody, for sure. So, let's talk about sort of in the environment, what are the most common culprits, if you will? How we can avoid them? Are we talking air pollution, humidity, extreme temperatures, you know, kind of all the above?

Van Holden, MD: Yeah. So, the most common exposure that can cause a COPD exacerbation is smoking. And it also causes a lung disease itself. And oftentimes when we think about smoking, we think about cigarette smoking, but it can be any kind of smoke. It can be secondhand smoke. It can be from smoking cigars, e-cigarettes, smoke from wood burning fireplaces or fire pits. So, the smoking itself can be a trigger for COPD exacerbations or worsenings. And then, other environmental triggers can be very extreme temperature, so being very hot or very cold outside. Pollen can make the breathing worse sometimes. High levels of pollution can also make breathing worse. And again, this isn't the same for everybody. It is different from patient to patient, so it's important to figure out what your individual triggers are.

Host: Yeah, that does seem to be the key. And it seems like, you know, some of these things, doctor, are hard to avoid, right? Temperatures, humidity. Or let's talk about indoors, we think about allergens, chemicals, sprays, they seem to be everywhere. So, how do we avoid them?

Van Holden, MD: So with the indoor triggers to everything that you mentioned, it can also include cleaning products as well. So, just considering what are your triggers, is it a certain scent, perfume? Even burning scented candles, incense, cleaning supplies, and trying to avoid those exposures as much as possible.

When the weather permits, it's helpful to have the windows and doors open to increase circulation inside the home. If it's hot or humid outside, using the air conditioner can help. And then if you do have to go outdoors and your trigger's outdoors, you can check the pollen index and the air quality index to see how likely your breathing or coughing may get worse.

Another tip would be to wear a scarf loosely around your head, if there's high amounts of pollution. And then, the other thing with indoor triggers is the most common trigger is a respiratory infection. So basically, stay away from people who are sick. Wash your hands very frequently and make sure you're up-to-date on vaccinations.

Host: Yeah. Maybe that's good advice anytime, right, doctor? Just sort of stay away from sick people, but especially if you have COPD. So, what are some of the key considerations when we try to avoid triggers and flareups?

Van Holden, MD: So, the key considerations would be to identify what your flareups or what your triggers are and avoiding them, stop smoking, and stay up-to-date on the vaccinations.

Host: Yeah. And of course, the smoking one for smokers is a tough one, right? And that would be maybe an entirely separate podcast, smoking cessation, of course. So, what does somebody do if they've been triggered? Do they use medications? Should they go to urgent care? And when is it time to go to ED or ER?

Van Holden, MD: Yes. So, exacerbations can be mild all the way to being very, very sick and severe. So, depending on how bad your symptoms are, meaning the cough, the amount of phlegm you're coughing up, your shortness of breath, then you'll have to decide whether you need to call your doctor or go into an urgent care center or emergency room. So, some patients may have had exacerbations before and know typically how severe they tend to get, but definitely inform your physician and they can help counsel you if you need to go to the emergency room.

The treatment for these exacerbations are generally breathing treatments, antibiotics, and steroids. So, sometimes exacerbations can be managed in an outpatient clinic setting. But sometimes if you're having a very hard time breathing, it's important to get an urgent evaluation right away. Patients often will have something called a rescue inhaler. So, it's an inhaler that they have at home that they use as needed. So if they have anything that feels like it got worse, like a cough, wheezing, shortness of breath, they can use this inhaler. But it's also important to use it correctly. And so, you can review your inhaler technique when you see your physician or even at the pharmacy.

Host: Yeah. And I'm sure as you're saying here, doctor, there's no one size fits all in terms of triggers and flareups and probably for treatment. And I'm sure folks who have COPD, because they've been used to dealing with it and living with it, they know what works for them, right?

Van Holden, MD: Yes.

Host: Yeah. So, any final thoughts and takeaways? It's always great to learn from experts as we've done here today. Final thoughts, takeaways about COPD and managing those triggers.

Van Holden, MD: I think the final takeaway is prevention. I think the best thing that we can do is prevent exposure to these triggers, which then helps you prevent exacerbations. So, figure out what your triggers are, avoid them, stay healthy, stay away from sick people, and stay up-to-date on vaccinations.

Host: Well, that's great advice for an expert. Thanks so much for being here today.

Van Holden, MD: Thank you, it's been a pleasure.

Host: And find more shows like this one at umms.org/podcast and on YouTube. I'm Scott Webb. And thank you for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.