When Breathing Gets Hard: Understanding COPD

Chronic obstructive pulmonary disease, referred to as COPD, is a progressive disease which can, over time, limit your ability to do basic activities such as walking, cooking or taking care of yourself. According to the National Heart, Lung and Blood Institute, it is the sixth leading cause of death in the U.S. and is two times more common in rural areas than it is in large cities. Tushi Singh, M.D., Texas Tech Physicians pulmonologist, is our guest for this episode. Dr. Singh explains to us what causes COPD, what treatments are available and what we can do to protect ourselves from developing COPD. 

Transcript

Melissa Whitfield  0:09 
Hello and welcome back to Texas Tech Health Check from Texas Tech University Health Sciences Center. I'm your host, Melissa Whitfield. We want you to get healthy and stay healthy with help from evidence based advice from our physicians, health care providers and researchers, chronic obstructive pulmonary disease, referred to as COPD as a progressive disease, which can, over time, limit your ability to do basic activities such as walking, cooking or even taking care of yourself, according to the National Heart, Lung and Blood Institute, it is the sixth leading cause of death in the US, and is two times more common in rural areas than it is in large cities. Dr Tushi Singh, Texas Tech Physicians Pulmonologist is our guest for this episode. Dr Singh explains to us what causes COPD, what treatments are available, and what we can do to protect ourselves from developing COPD.

Melissa Whitfield  1:23 
Dr. Singh, welcome to our podcast.

Dr. Tushi Singh  1:24 
Hi. Thank you, Melissa. Thank you so much for having me here today.

Melissa Whitfield  1:28 
How are you doing today?

Dr. Tushi Singh  1:30 
Good, good.

Melissa Whitfield  1:31 
Can you tell our listeners a little bit about yourself and what you do here at the Health Sciences Center?

Dr. Tushi Singh  1:35 
Yes. So my name is Tushi Singh, and I'm a pulmonologist. I'm currently employed as an assistant professor in the Department of Pulmonary and Critical Care Medicine. I am from India, and I was a pulmonologist back home, so I've been a pulmonologist for close to a decade now, and it gives me such immense joy to be practicing my specialty in this beautiful city of Lubbock.

Melissa Whitfield  1:59 
Well, welcome to Lubbock. Welcome to Texas and Welcome to Texas Tech Health Check.

Dr. Tushi Singh  2:04 
Thank you. Thank you very much. What questions can I answer for you today?

Melissa Whitfield  2:07 
Well, our topic for this episode is COPD. Can you can you tell us what is COPD, and does it affect only certain age groups, or maybe just women or men or one or the other a little more?

Dr. Tushi Singh  2:21 
Yes, absolutely. So COPD stands for chronic obstructive pulmonary disease, and I'm really glad that you've chosen this topic for our podcast, because among the causes for mortality in the entire world and also the United States, COPD features in the top three reasons. So it's really important that we spread awareness about this condition. COPD is commonly of two varieties, and it's characterized by air flow obstruction, which is a scientific way of saying breathing issues, and the most common age group it effects are the ones between ages of 30 to 60. And interestingly, epidemiological data from around the world and even in our country shows that it's vastly under diagnosed. So far as predilection for a certain gender is concerned, I am not aware that it affects one gender more than the other. And as we go through this discussion, I'll be able to tell you about what the causes for COPD and what ways COPD manifests itself of, and we can understand this a little better.

Melissa Whitfield  3:35 
So then, what are the symptoms and how do you diagnose it?

Dr. Tushi Singh  3:39 
So COPD can result from two conditions. The less common variety is when you hit the genetic lottery in the wrong way and you get some enzyme deficiencies. That's not very common. And when that happens, it manifests in younger age groups, like in your teens to early 20s, the more common variety of COPD is the result of chronic exposure, or long term exposure to tobacco, smoking, environmental pollutants, exposure to wildfires in the forest, occupational exposures to fumes and gas. People who work in automotive industry, people who are exposed to smoke from welding. So these are the groups of people that are most vulnerable to developing this condition. So what really happens is exposure to the smoke starts to damage your airways and your lungs, and the most common manifestation of this damage is shortness of breath, which is medically called dyspnea. So the most common symptoms we see is with time, the dyspnea keeps getting worse, and it's not uncommon for people to attribute it to plain, simple aging, and this is what causes delay in seeking medical care. The other thing we often see is cough. A lot of people have cough, which can sometimes have phlegm associated with it, and wheezing is pretty common. And whenever we see these myriad of symptoms in patients who have the risk factors that I just mentioned, we start thinking of COPD.

Melissa Whitfield  5:23 
What are some complications that could result from undiagnosed COPD?

Dr. Tushi Singh  5:28 
That's a very good question. Whenever I get patients to my clinic that complain of shortness of breath, cough and have a history of exposure to gasses, like environmental pollutants, fumes, or something as simple as cigarette smoking. And I think that they might have COPD I go on to confirm this, I send them for some basic tests in the laboratory. I do a chest X ray, and I do what is called a pulmonary function test, which gives me an idea of how exactly the lungs are doing. The reason we do all this is if we were to not diagnose it, if we were to let it go, COPD can worsen over a period of time and shorten a person's longevity. Not only that, it can significantly impair their ability to work. So this is going to have social consequences, economic consequences, and like I mentioned, consequences on your longevity. So this is the reason why we want to diagnose it and treat it.

Melissa Whitfield  6:36 
Now you did mention some of the causes of COPD, but is this just something that happens long term? Do you have to be exposed to it for a long time, or is it short periods? What would cause it?

Dr. Tushi Singh  6:48 
That's a very good question. Yes, oftentimes the exposure is long term, over a period of years, if not decades, and the damage that occurs to the lungs is because of constant exposure that takes place over a long period of time. And sometimes it can happen that exposure to high quantity of noxious gasses. Sometimes we see this in our military vets, you know, who've been exposed to burning pits, but only for a short period of time, but they can still have after effects from the damage of exposure to these noxious gasses, but the more common variety that we see, which results from environmental pollutants or cigarette smoking, is because of exposure over a long period of time.

Melissa Whitfield  7:36 
So how do you treat it?

Dr. Tushi Singh  7:38 
Well, the first step is to diagnose it, and once I confirm the diagnosis, then the treatment involves first classifying the severity of the condition, and this is the reason why we do that test called pulmonary function tests. The way I often explain it to my patients is the X ray tells me what your lungs look like, and from the looks of it, sometimes it can be deceptive. It might look completely fine, but does it mean it's working fine? And to confirm that we like to get a PFT, a very funny analogy I give my patients is when you look at me, I look like I could run a marathon, but can I run a marathon? So this is what the PFT tells me. It helps me classify the severity of their COPD. So it's categorized into four classes, the mild variety, moderate, severe and very severe, depending on the class in which my patients fall, I offer to them different kinds of inhaler therapy that we have. Inhalers are the first line treatment for COPD, but they are not the end all be all for COPD. Once my patients get the hang of using the inhalers. And this is besides making sure that we are able to eliminate the reason for COPD, for example, as is most common, if they tell me that they're smoking, of course, I will provide them with all the possible resources to help them quit smoking. Or if it is because of noxious gasses at their workplace, we talk about ways in which we can avoid that, either using mass or changing the work environment and such and such. Then we bring in the inhalers after the inhalers have done their job. And for this, I think it's very important to counsel our patients, so we set realistic targets. This is one place where I think us physicians are lacking a little bit. I often tell my patients that inhalers, as shown on the television, isn't always a magic bullet. One puff and everything goes away. Rarely happens, especially in COPD. So I tell my patients that for the inhalers to show its maximum benefit. They need to be used as prescribed for at least two weeks, and that's when you can start to feel a tangible benefit. The other things I often help my patients with is pulmonary rehabilitation. We do have a pulmonary rehab center right here at Texas Tech, and 99.9% of the patients I send to pulmonary rehab come back telling me how good it feels, how great their ability to exercise is, and that goes a long way in keeping COPD from progressing, staying physically active. So pulmonary rehab is something we offer all of our patients. As the disease progresses, and oftentimes we see that patients come to us in advanced stages they can benefit from being on supplemental oxygen. A common question a patient asks me is, is this addictive? No, it is not addictive. When the doctor tells you that you need oxygen, use the oxygen so that you can experience a better quality of life and also prolong your longevity. So when I suggest, or any physician suggests that you need oxygen for a lung issue, it goes without saying that you should be using it for a minimum of 18 hours a day. And if we suggest oxygen goes without, saying, please do not smoke while you have your oxygen on. Take off your oxygen while you're near the stove. Take off your oxygen while you're near any incendiary devices, anything that can trigger a spark, because we do not want any fire accidents. Some of the other options that we have available for COPD patients is volume reduction procedures, but for this, there have to be specific criteria met. The reason I'm bringing it up is because 20 years ago, there was not a whole lot we could do for COPD, but that's not the case anymore. We do have many treatment options available, and using this platform, I hope, to educate patients so that they do not get depressed and lose hope just because they have been told they have COPD, there is still a good chance that they will be able to lead a good quality of life and be able to perform activities at levels that were not previously possible for them.

Melissa Whitfield  12:30 
Now, on this podcast, we use this platform to remind people to stop smoking. So having said that already, is there anything else that people can do to prevent getting COPD.

Dr. Tushi Singh  12:41 
So once COPD develops, then we are looking at preventing the COPD from getting worse. So like I mentioned before, and like you brought up, smoking cessation goes a long way in achieving that target, and if it is possible for you to change your work environment where you might be getting exposed to noxious gasses, that would be a place to focus on if your significant other or loved ones smoke around you, you want to encourage them to stop smoking, and if they won't, at least put yourself out of their range of smoke area so that you don't suffer from the effects of smoking.

Melissa Whitfield  13:24 
So then, how can we support loved ones with COPD?

Dr. Tushi Singh  13:28 
That is such a good question. Whenever I get patients with COPD, I often see that they tend to do better when they have support from their family and loved ones around them. The few things that research over the years have shown to improve patients, longevity and performance are number one, like I mentioned, physical therapy or pulmonary rehabilitation. Number two, if you need oxygen, keeping the oxygen on. Last, but not the least, vaccination. One of the most common causes for my patients of COPD to succumb to their disease is a COPD exacerbation. And the most common cause for exacerbations that we see are infections, infections from environmental bacteria. Now remember, somebody that does not have COPD, somebody younger might have a very mild manifestation from a simple infection, but because patients with COPD already have a damaged lung to begin with, the manifestations of infection are way more severe, so the only way to prevent that is by making sure you protect yourself with vaccines. The more common vaccines that we always recommend are the pneumonia vaccine, which you should definitely be getting if you're over 65 years of age or under 65 and you've had the diagnosis of COPD, your annual flu vaccines, the RSV vaccine, the Tdap vaccine, the help of Zoster vaccine. These little things go a long way in helping you live with COPD.

Melissa Whitfield  15:14 
Is there anything else that you would like to add?

Dr. Tushi Singh  15:18 
Well, like I mentioned, COPD is a very treatable condition. COPD claims several lives. COPD is not to be feared. Please have yourself tested if you're somebody who has smoked a pack of cigarettes a day for at least 10 years, or you're exposed to noxious gasses, either at workplace or at home or because of wildfires around you, and then you notice that you're not able to keep up with your peers because you're short of breath, or if you have chronic cough, or if you Just have any doubt whatsoever, please reach out to your primary care physician, let them know that you want to get tested for it. If we nip it in the bud, there is a good chance that you will continue to lead a long and healthy life.

Melissa Whitfield  16:16 
Thank you so much for coming on our podcast talk about COPD and telling us what it is and what we can do to not get it.

Dr. Tushi Singh  16:36 
Yes. Thank you for having me and like I said, if you suspect it, please get yourself checked out by a physician, and do not let the diagnosis of COPD let you down and make you lose hope, because, like I was saying, once we diagnose it, we can very much treat it, and you'll be able to go on the mountain hike you always wanted to. You could go on a plane trip that you wanted to, and you could do so much more, even once you have the diagnosis of COPD.

Melissa Whitfield  17:07 
Thank you.

Dr. Tushi Singh  17:08 
You're welcome.

Melissa Whitfield  17:11 
Thanks for listening to Texas Tech Health Check. Make sure to subscribe or follow wherever you listen to podcasts. This information is not intended to be a substitute for professional medical advice. Always seek immediate medical advice from your physician or your health care provider for questions regarding your health or medical condition. Texas Tech Health Check is brought to you by Texas Tech University Health Sciences Center and produced by TR Castillo, Suzanna Cisneros, Mark Hendricks, Kay Williams and me, Melissa Whitfield.