Understanding COPD - causes, signs, symptoms and treatments

COPD short of breath coughing all the time do you have COPD welcome to another episode of talking with docs I'm Dr Brad weening and I'm Dr Paul zza we have a guest today Dr Lawrence Chow who is a respirologist with us kindly grac us with his presence in his time and is going to teach us today thanks for coming along Dr Chow there is a rumor going around that the internal medicine types like the respirologists and that are much smarter than orthopedic surgeons I think it's true so I'm very glad I'm very glad that you're here to talk with us today about this topic and today we're going to talk about COPD right so let's start at the beginning what is COPD well COPD stands for chronic obstructive pulmonary disease it's really quite straightforward um to make the diagnosis we have to show airflow obstruction which basically means you have to do this little test called spirometry the little Gadget you just blow hard into it take a big breath and blow all the way out as fast as one can do it and this is to see whether you cannot empty your lungs as quickly as you should and if you cannot do that then you likely have COPD though there are other possibilities like asthma so put in the right context that's how we confirm the diagnosis of COPD chronic obstructive pulmonary disease okay so what are some of the symptoms someone might have so if you're one of our viewers is thinking Bo I wonder if I have COPD what are some of the symptoms they might have um for most patients um usually they present with shortness of breath that's how they sort of see their their doctors uh often they would have coughing sometimes with secretions with sputum um some patients may not have any symptoms uh but it could be picked up because their family doctors are diligent and they have like smoking history they would do a spirometry to uh look at screen for this condition because we want to pick up this condition before it gets symptomatic because usually is not very reversible so it's usually important to diagnose early on okay and so you brought up one of the things so would you agree that there's three main groups of risk factors for these group of people so smoking for sure is by far the number one would the second group be an umbrella of environmental factors like exposures to dust or Workplay solvents or or those kind of things or that would be the other one and then the genetic one which is very uncommon but very severe the Alfie one alpha1 antirion disorder right right so uh for most patients I would say possibly like 90% are smokers right uh expens especially long-standing smokers know one to two packes daily but sometimes it can be be as much as that but it's unlikely that you get cop just know smoking a few cigarettes here and there but usually at least you know 10 to 15 packes um but there are also a second group um caused by exposure to um pollution for example secondhand smoking we see that a lot you know especially in the old days you know they live in homes where the parents are heavy smokers you know they sit in the car and every smoking in the car with the windows up I remember that as a kid yeah that's right we all experienced that right um and then um in in in developing countries um we're also concerned with the biomass fuel where they they use fuels at home for cooking and heating maybe wood or um some alternative kind of fuel and it's very smoky and full of suit and things like that and all the small particles can enter the lungs just like smoking right and extensive exposure to to to these pollutants can also result in COPD we also see um sometimes patients um with um prematurity at Birth causing some damage to the lungs and even children with pneumonia can result in damage to the Airways causing COPD so we're seeing some patients with no smoking history and they end up with severe um airf flow obstruction and that's would be the second group and then there's the the third group that you mentioned with the genetic predisposition the most common one being alpha1 in trips and deficiency where the lungs are damaged because of the deficiency of this chemical um that is not produce it can also affect the liver and the lungs on on the secondhand smoke thing CU that's my situation I never smoked a cigarette in my life however I did grow up in secondhand smoke H is there a way to quantify that or you know if that was so many years ago has my rist gone back down to Baseline now or once you've been exposed you carry that risk for the rest of your life how does that work yeah it's very difficult to quantify it because like you know how exactly do you quantify that it's all by history and it's almost impossible but uh we do know that it makes a difference um the effects are probably not that bad because you're not directly smoking the cigarettes with all the bad things you know generated from burning cigarettes at thousands of degrees right um but we do think that there is some improvement with time especially things like know lung cancer if you haven't been exposed to it for so many years the risks are perhaps lower but never back to zero okay um with COPD is a bit different because once you have it it's irreversible right okay and in this don't open a can of worms here but in the smoking pile is vaping in there at all or is vaping a completely different set of lung issues yeah vaping it's uh is another kind kind kind of worms um we don't have that much um experience or data because vaping is more in the last s decade or so uh we do know that vaping is is not good and we certainly discourage vaping um except perhaps in the context of patients to really try to quit smoking they just couldn't do it yeah um despite you know using nicotine patches and all those things that we have available to help they really really couldn't do it sometimes we would say perhaps vaping is less dangerous and some authorities have uh have positioned themselves to suggest using that as a way of trying to get off smoking certainly you know young people teenagers we see a lot of them vaping and we're worried that that's a segue into smoking in the long term because they're addicted to nicotine which is often used in the in the The Vaping juices um so vaping is not good and we know know there's this entity called um um e e eval EV Val uh ecigarette vaping Associated lung injury that was first reported back in I think 2019 and there are now thousands of patients including some deaths mostly in young people because they vaping substances that are actually damaging to the lungs okay maybe another video going into more detail we did do a video a while ago about vaping and and we did get a lot of comments back from people who seem to love vaping uh so it's good to have aist here to uh yeah we don't we don't like that we tow the line here on don't Vape okay so in terms of COPD not really relevant The Vaping thing but definitely smoking is a secondhand smoke right so so under COPD we have both empyema and chronic bronchitis is that correct yes those are the main two entities right and one of the diagnostic criteria is the duration of the symptoms right so if you have bronchitis for 2 weeks you don't have COPD because you're missing The Chronic part yes you go to your family doctor you've had more than 3 months in the last two years or was that still the criteria would you say yeah so that's the criteria for chronic bronchitis yes so chronic means longterm right right if you're just coughing for a few days for a few weeks because you had a cold or no covid or whatever or influenza RSV those are the main three viruses now um then that's acute bronchitis right acute for chronic bronchitis is longterm so the definition as you mentioned is U quite simple coughing usually with production of SP them for at least 3 months in a year at least 2 years in a row okay if you do that you likely have chronic bronchitis right so then so you're at your doctor you had your physical exam and and the physical exam may or may not show something right you might hear what we do on what so I've had those symptoms that you talked about shortness of breath um maybe some coughing or I maybe got picked up uh asymptomatic you go to the doctor what's going to happen on physical exam well um we certainly would uh examine you especially listening to your chest um sometimes you may not find very much examination is not particularly sensitive especially for the mild cases in fact you may not find anything in the severe cases especially with empyema they can have we call um um U big lungs and um when you when you sort of chest the the check the lung expansion is not as big and when you take a big breath the lung doesn't doesn't expand as well and sometimes the lung goes goes in sideways like um because because of the mechanics of distorted lungs um when you listen to the lungs sometimes it's quiet you don't hear the breath sounds as well sometimes you can have hear you can hear some wheezing you can sometimes hear some um gurgling sounds because of the secretions in the Airways sometimes there are crackles which has like like like velcro crackling sounds in the lungs okay um to suggest maybe secretions in the Airways docs basically going to watch your breathe and listen to your breathe and collect some information about that on physical examination and then some investigations and you had mentioned one spirometry but anything else so maybe just tell us again what spirometry is yeah so the spirometry is is the little Gadget they're very small these days and um basically inside it there's this little device that um uh measures how how how much air flow there is how fast air is going through the device and you take a big breath and then there's a mouthpiece seal the lips on it and just blow out as hot as you can right we have to us like you know six to 7 Seconds completely empty out your lungs and so that's your F right so f one is the forced EX volume in 1 second a if you want how much air you blow out in 1 second and we compare that to the fvc which is the forced fital capacity how much air you can blow out from the beginning to the very end in one breath okay and usually we look for a ratio of 0.7 at least getting 70% of your full breath out in that in that first second so suffice to say a bit tricky if you want a career as a clown where you blow up those balloons and tie them into different animals probably going to need a pump for that well yeah especially if you're smoking the same time yes so so now your family doctors made your diagnos they say we're convinced that you have chronic obstructive pulmonary disease do they start treating you or would they typically send you to a respirologist or is that a little bit of a dealer's Choice um they don't usually have to send to respirologist right away um especially if the patient's are mild a lot of counseling to see you know whe the patient is smoking or not most important thing is to quit smoking number one treatment stop smoking stop smoking or stop exposing yourself to all the fumes whatever is around you okay uh that's the most important thing because it's irreversible right and if you continue to smoke your lungs will continue to get worse so it'll be irreversible and Progressive and Progressive absolutely they've done lots of studies to show that it's it's irreversible despite all the medications we have medications can help to reduce symptoms but it does not reverse the process unfortunately and so the purpose of treatment at this point is to to reduce progression but also to improve your quality of life in the shortterm entally being short of breath okay so are there any medications people our viewers love big pharmacology they really love no they don't hate big so are there any medications that can help someone with COPD to have a better quality of life now that they've quit smoking absolutely absolutely there are basically inhalers or what call puffers um there are many many different ones now I mean the list is so long but basically they have there have several groups um the simplest is the what we call the short acting beer2 Agonist um the salamor venin which is like a blue puffer right it basically relaxes the smooth muscles that goes around and around the Airways so the Airways can open up a bit and uh um and then one can breathe a bit easier because the Airways are more opened um they don't last very long about six 6 to 8 hours and usually used as needed so that's the short acting B2 Agonist there's also long acting B2 Agonist that last like 12 to 16 hours some of them even 24 hours so that's usually used once a day supposed to as needed because it's long acting and then there's the antimuscarinic group or Lama which is basically another Bronco dilator but it doesn't work on the beta to um um beta receptors it work on different receptors that also allows the Airways to open up so they're two basically those two groups that are what called Bronco dilators and then lastly there's the steroid group right and the steroids are inhal steroids that um help to minimize Airway inflammation because with COPD as well as in asthma there's a lot of inflammation in the Airways steroids sometimes is a bad word but steroids in medicine helps to reduce inflammation sometimes can be life-saving and it's helpful in COPD okay and then would antibiotics ever play a role in empyema or COPD like with the bronchitis side um generally not except uh in certain situations for example when you have what we call an acute EX mation meaning that uh your symptoms are suddenly a lot worse for days and weeks usually because of a viral infection causing uh further uh inflammation in the Airways causing further narrowing in the Airways causing increased spent production so you're coughing more more breathless uh sometimes in that kind of situation there's antibiotics with steroids these are steroid pills usually for 5 to 7 days that can help to limit the duration of the COPD exacerbation in some COPD patients usually severe with frequent flareups frequent exacerbations um we do put them on one class of antibiotics longterm using it every day because that class of antibiotics have been shown to have anti-inflammatory properties that can help to minimize some of the symptoms and more importantly minimize the frequency ofs that's the the well the aiyin whichit in particular interesting okay and then sort of end stage getting really bad you tried all this stuff when are you looking at oxygen at home or home oxygen does that ever does people ever get to that so absolutely so we do check patients uh for uh oxygen level and these days it's very convenient you've all seen the oximeter that little thing you put in your yeah you that may not be as accurate that may not be as accurate but it's pretty good um but there are oximeters that you put on your finger that's small little problem I'm sure we've all seen that that's fairly accurate um and that can quickly tell us what your oxygen level is so most people often feel when they're short of breath the oxygen level is low and that's often not the case the right not the case you well yeah exactly you can be short of breath with normal oxygen level so if I strangled you right now you got really short of breath but your oxygen level wouldn't have dropped a single bit right aggressive smart aggressive smart aggressive um but um if your oxygen level is chronically low and also if your oxygen drops to a significant degree with exertion then yes we do prescribe oxygen okay and are we talking like when it's because people are going to look and they're going to say well my SAT s of 97 or 96 is there a specific Target number or it's a combination of the number and the symptoms uh most of the time we like to see it like over 90% um uh or above that is not really going to help very much um it's it's not like you need to be 99% 100% it's like going to school you know you need to be 100% or anything um anything usually over the high 8s PTSD yeah exactly so usually over like 88% over 90% is adequate um there's a lot of um redundancy in the system uh the bottle neck is no longer the oxygen once you get it like over 90% in patients with B complicated no but with high CO2 level we don't like to see it more than 92% so the lowest number we would pick is usually about 88% okay and then lastly as surgeons I looked into this and so Nate stage there are some theoretical benefits of surgery and three main procedures that I noticed and it was that the bullectomy for the empius patient that has big large areas that don't have normal alveoli a lung reduction surgery or a lung transplant how often is surgery actually done for COPD oh it's very rare it's very un common right yes because it's high risk and the patients are complicated high risk absolutely um I think I would say less than 1% yeah so this is not something that if you have cop that youed be thinking I'm just going to get surgery after it's all said and done it's really a very viable option for most people no and especially lung transplant um know if you're your 70s and ' 80s you know got to get lung transplant for COPD if you're in your 30s 40s 50s maybe in your 60s and you have really bad lungs and you just know really poor quality of life and you're otherwise healthy that may be considered sure and often we see that in that genetic group with Alpha 1 Alpha 1on deficiency where they can get COPD you know in their 40s and 50s um those are patients that we may consider lung transplant okay wow that is a big they were right respirologists are way smarter than it's not a myth that was a that was an excellent summer and I think it's going to help clarify some things for our patients so now you know if you have COPD if you have symptoms like this talk to your doctor about COPD and remember you are in charge of your own health and if one of our viewers quit smoking because of this then it was a success AG abolutely thanks Dr Chow for joining us and we'll see you next time

Channel: Talking With Docs

Views: 29,508

Keywords: health (industry), medicine (field of study), disease (cause of death), osmosis, pathology (medical specialty), what is, nursing (field of study), nursing school (organization), copd, patient, animation, lung, symptoms, chronic obstructive pulmonary disease (disease or medical condition), ninja nerd lectures, ninja nerd, ninja nerd science, chronic obstructive pulmonary disease, chronic bronchitis, pulmonary medicine, emphysema, copd pathophysiology, copd management

Id: Ng1H1FPb5v8

Length: 17min 33sec (1053 seconds)

Published: Wed Jan 17 2024