Understanding COPD: What patients and providers need to now

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-hosts Dr. Rajay Seudath and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Rajay Seudath.

CARMENN MILES
Welcome, everyone. We're delighted to have you with us on the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles, alongside our co-host for today, Dr. Rajay Seudath. You can find Docs in a Pod on any music podcast listening platform. You can also find us on the radio in several Texas and Florida markets. Each week, we huddle together with the experts to discuss health and wellness topics, especially those that tend to impact our seniors. Our goal each week is to share practical information on how we can all live healthier, happier lives, and to help us better manage some of those pesky chronic conditions. We're thrilled you're spending part of your day with us today. Regular listeners, you're already familiar with our great co-host for today, Dr. Rajay Seudath. He's basically a celebrity around here, and he's certainly that and so much more to his patients, minus all of the pretentious Hollywood stuff that comes with celebrity. He's a proud Tampa native. He's a board certified family medicine physician and the lead physician of the University location for Optum. He brings so much passion to primary care, and honestly, he makes health literacy sound so fun. So much so that you almost forget you're learning some pretty important stuff regarding your health. Hey, hey, Dr. Seudath.

DR. RAJAY SEUDATH
Hey, hey, Carmenn. Happy to be here.

CARMENN MILES
Good. We're glad to have you. Let's go straight into this and let's welcome our guest, Dr. Rodrigo Pereira. He's a board certified family physician of Optum. He earned his medical degree from Universidade Federal Fluminense in Brazil, and he completed his residency in family practice at Tallahassee Memorial Hospital in Tallahassee, Florida. Dr. Pereira is certified by the American Board of Family Medicine. He is dedicated to providing compassionate, patient centered care and building long term relationships with his patients. Outside of medicine, he enjoys running and traveling, and so far he's visited more than 20 countries. Well, hello, Dr. Pereira. 20 countries. That's pretty impressive. Do you have a favorite?

DR. RODRIGO PEREIRA
Yes, Japan for sure. I need to go back.

CARMENN MILES
Very good. What is it about Japan? Convince me that I need to go. What are a couple things?

DR. RODRIGO PEREIRA
It's so organized, so clean, so peaceful. The nature is beautiful. It was really amazing.

CARMENN MILES
I have heard lots of information about the nature there and just how clean it is. Everybody seems to talk about how clean Japan is. Well, welcome to the show. We're glad you're here today. We're talking about COPD or Chronic Obstructive Pulmonary Disease. Whether you're newly diagnosed, you're caring for someone with COPD or just want some clear, trustworthy information, this episode is for you. Dr. Pereira, I believe in starting from the ground floor and building from there. So, let's just start with explaining what Chronic Obstructive Pulmonary Disease is. I've personally heard it referred to as the SmokerÕs Disease, but that's not always the case now, is it?

DR. RODRIGO PEREIRA
No. Smoking is the number one cause, but there are other causes as well. COPD, Chronic Obstructive Pulmonary Disease, is a chronic respiratory condition where you can have symptoms like shortness of breath, cough, sputum production. It's usually something progressive, meaning that it gets worse over time. It's something we can prevent. It is something that we can treat. It is the third cause of death, and close to 40 to 50% of people that have it, they don't know that they have it. So, it's a very important disease for you to know about.

CARMENN MILES
If they are not aware that they have it, but they have shortness of breath, how do you determine as a medical professional that someone is suffering with COPD? Does it come out in their blood work? Tell me a little bit about that.

DR. RODRIGO PEREIRA
Usually, you have someone with a history of exposure to something that was toxic to their lungs, somebody that has been smoking for a long time. But you might also have somebody that was exposed to chemicals or fumes at their work, or there is this genetic condition where somebody is already predisposed to develop COPD as they get older. But you have somebody that has been presenting with this, progressive shortness of breath initially with exertion, somebody with chronic cough, somebody that has been producing a lot of phlegm. So, you have this clinical picture, but there is a test we can talk about later that explains how to be tested for that.

CARMENN MILES
Very good. Let's take a moment to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles alongside co-host Dr. Rajay Seudath and our guest for today's show, Dr. Rodrigo Pereira. Our podcasts are available wherever you listen to your podcasts. You can also find us on the radio in several Texas and Florida markets. Today we're discussing Chronic Obstructive Pulmonary Disease, better known to most as COPD. Some referred to it as the SmokerÕs Disease, but as Dr. Pereira just explained, it's not. While smoking may be one of the lead causes of COPD, there are many other factors as well. Is this something that could possibly run in the family? Tell me a little bit about that. You talked about long term exposure to air pollution or maybe some dust or something in the workplace, repeated lung infections, I imagine, may be indicative of COPD. If you will just continue on with what you were sharing before the break.

DR. RODRIGO PEREIRA
Before we were talking about how to get diagnosed. You have that clinical picture of the patient that has the shortness of breath that's going progressive. This chronic cough. When we suspect somebody might have COPD, the only way to confirm that diagnosis is doing a test that we call spirometry. COPD is a condition where you have difficulty to amp your lungs to move air out of your lungs. So, we do this test where you have to blow into a machine, and we measure how much you can blow in one second, compared to how much you can blow and to amp your lungs. Because you have this narrowing of the airways, and itÕs difficult to move air out, you're unable to have a good volume in that first second. So, we are able to measure that and then we can do the diagnosis. That's interesting because that's how we can also differentiate the patient with COPD from somebody that has asthma. Those are two conditions that we see quite often because we usually do this test before and after we do a breathing treatment. With asthma, we see somebody with similar symptoms, but they tend to get much better after they use this drug that opens the lungs, the bronchodilators. But yes, to make a diagnosis, we need that spirometry.

CARMENN MILES
Does the reaction to the medications help you determine whether it's COPD versus asthma? How do you differentiate?

DR. RODRIGO PEREIRA
With COPD, you have this chronic inflammation of the airways that caused this narrowing of the airways. So, when you do the bronchodilators, you might show some improvement, but you don't reverse the damage. With asthma, which is more of an inflammatory condition with spasm of the airways, you tend to see a much bigger improvement after you use a bronchodilator. We call that reversibility. So, that's kind of the difference. With asthma, that improvement is much better and can measure that with bigger numbers. That's kind of the difference.

CARMENN MILES
Dr. Seudath, I'm curious to know, is COPD curable or is it something that once you're diagnosed, you just kind of find the best way to manage it? I imagine that treatment is personalized based on the severity with each patient. I don't know, I'm just guessing, but I know you'll set me straight.

DR. RAJAY SEUDATH
Yes. It's a chronic disease. It's not necessarily curable. If a person is still smoking, which is again, the number one cause of COPD. If we can get them to stop smoking, that can decrease the progression of their disease. There is a stepwise treatment. We do bronchodilators like Dr. Pereira was saying. Things to open up your lungs. We start off with those, but the mainstay is a daily inhaled medicine. One to open up your lungs for a longer period of time, and then one to either decrease the inflammation, which is a steroid, or one to help, with mucus production, which is a different type of anticholinergic. There are medicines that have two agents in them, and now there's medicines that have three agents in them. So, it's become a lot more convenient to treat them. So, the answer to your question is that damage, especially if it's from smoking, will continue. That's why it's a progressive disease. That damage will continue throughout their life. I have patients who will say, Doc, I only smoked for 20 years. But that's 20 years of day in, day out damage, and now that they're in their 60s or 70s or 80s, it's starting to catch up with them. So, we are trying to do everything we can to treat the disease. There are lifestyle changes we can do. There are other things that we can try to improve their symptoms, but again, it is not curable.

CARMENN MILES
We talked about inhalers and different medications and steroids. Ever had a hard time managing a case? What are some of the worst case scenarios that you've seen, and how hard was it to manage the condition?

DR. RODRIGO PEREIRA
I think the difficulty happens when the patient is getting progressively worse and they continue to smoke, and then they keep having exacerbations back to back to back. With exacerbations, you have to use steroids like higher doses plus antibiotics. Patients that sometimes are already using oxygen, but they continue to smoke. I think one thing that happens too is that very often you have a patient that has COPD, but they also have other medical conditions. So, you're dealing with the COPD in a patient that also has heart failure, uncontrolled high blood pressure, or you have to start them on steroids, but they have diabetes. So, that makes it a little bit more complex and more difficult.

CARMENN MILES
Very good. Thank you for sharing that with us. We need to take just a quick break, but please stay with us as we continue this great discussion on COPD. You're listening to Docs in a Pod presented by WellMed. WeÕll be right back.

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CARMENN MILES
We're back on Docs in a Pod presented by WellMed. I'm your host, Carmenn Miles, alongside cohost Dr. Rajay Seudath and our guest today, Dr. Rodrigo Pereira. Today we're chatting about Chronic Obstructive Pulmonary Disease, or COPD. Dr. Seudath, dig a little deeper into the lung function in the midst of COPD. How is it functioning? How do we get it back to where we need it to be in order for some of these symptoms to be addressed? Tell us what happens to the lungs when COPD is in the picture.

DR. RAJAY SEUDATH
Let's start with normal lungs. Normal lungs are like a balloon. So, you have to put air into a balloon, but you don't have to squeeze a balloon to get the air out. It's naturally elastic. You blow a balloon up and you take your lips off and naturally, the air comes out. COPD lungs are different. They're more like a plastic shopping bag. So, if you had one of those bags and you made it into a hole and you blew into it and it blew up and then you take your hands off, it doesn't deflate. The bag just kind of stays where it is. That's what COPD lungs are like. Oftentimes we tell people with COPD, I want you to do some deep breathing exercises. But deep breathing exercises for COPD people are not just in and out as much as you can. They have to be slow, controlled measured breaths in and then slow controlled measures breaths out. Typically, I tell my patients I want them to breathe out through a small hole like they're blowing out a candle. I want them to do an extended blow through that. You'll notice if you even now, even the folks who are listening, if you take a breath in and then you breathe out with your mouth open, you only get so much out. But if you take a breath in and then you breathe out through a small O, you get a lot more out. That pressure in your lungs is able to get more of that air out. So, that's kind of the way I try to tell my patients, this is what's going on in your lungs. This is what I want you to visualize. Get that old air out. Sometimes that helps them to visualize and to think about what are the ways that we're getting them to participate in their health. Actually, the VA has a system. They actually had a choral group where they would teach COPD patients to sing, or I think some of them have a harmonica group where they teach people to play the harmonica to try and get them to control their breathing. Again, to specifically work on getting the old air out through singing or through harmonica or other things. I think that's really interesting.

CARMENN MILES
That is very interesting. It makes me think of my days back in the day, playing first chair flute. You really had to control your breathing, right?

DR. RAJAY SEUDATH
I was the trumpet man myself.

CARMENN MILES
Oh, where are you?

DR. RAJAY SEUDATH
Loud and off beat. That's me.

CARMENN MILES
Nothing wrong with that. I'm curious to know. This is maybe a silly question, but does it only affect when you're blowing out versus in?

DR. RAJAY SEUDATH
Well, it's kind of both. If there's a bunch of old air inside of your lungs, you can't get the new air in. So, that's part of the issue. If a person is having an exacerbation, meaning their lung function is getting worse because they were exposed to some allergy, some pollen, they caught COVID or flu or even the common cold can do it if they're in the hospital and they can't breathe. A person who's having a real bad exacerbation, they feel like their lungs are tight. If you want to see what it feels like to feel like you have COPD, take a small Capri Sun straw. Put that in your mouth and breathe through that for about two minutes. That's what it feels like. It's like there's air in your lungs you're trying to get out, but you can't get it out to that little tiny, that tiny, thin straw. That's what it feels like.

CARMENN MILES
Very limited. Very constricted.

DR. RAJAY SEUDATH
Yes.

CARMENN MILES
Dr. Pereira, let's talk about a flare up. If you have a patient who is having issues breathing, they're constricted for some reason, and maybe comes out of nowhere, or maybe it just kind of worsens over time, but they are having some of these symptoms. What is your recommendation for that patient in that moment? Maybe it's 10:00 at night, but if they're having these issues with breathing, they're feeling fatigue, should they call you first? Should they go to the emergency room? What are your thoughts on how they should address flare up?

DR. RODRIGO PEREIRA
I actually like when they call me first. One of the things that we do here, we create an action plan for my patients. We usually have it written so they know exactly what to do, when to call. So, we have symptoms that we say this is green zone here. Everything is going according to the plan. We don't need to make anything different. The yellow light is when you start having some symptoms. That's the time you have to call me. So, you've been using your rescue inhaler more often. You've been feeling more short of breath, more fatigue. There was a change in your cough. That's usually when I can intervene. There is the moment where you go into the red light like shortness of breath is severe even at rest. You have chest pain. That's usually when you have to go to the hospital. But if I'm able to see the patient before they actually have to go to the hospital, it's important to actually learn what caused that exacerbation so we can already anticipate what we're going to do different in the future, but that's the time that we very often have to start the patient on some steroids to reduce that inflammation and some antibiotics to treat that as well. As well as the use of the bronchodilators like albuterol so we can open the airways. That's the time to see what went wrong so it doesn't happen again.

DR. RAJAY SEUDATH
To build on that with Dr. Pereira, oftentimes primary care offices can treat your COPD exacerbation. Even as a person is starting to feel a lot worse, what we can do in 45 minutes sometimes it takes the E.R. four hours to do. It's not a knock on them, it's just a COPD exacerbation is severe. But a guy who's in a car wreck and his heart has been disengaged from his aorta. That's a major emergency. I have patients who go to the E.R. and say, they check my blood pressure, they gave me a shot, and then they made me wait eight hours. Oftentimes, your primary care office can get you in if you can contact them. So, yes, call us first. Call us first. Call us first. We will absolutely try to get you in because the things that they do at the E.R., they're giving you a shot of steroids. They're giving you a shot of antibiotics. They're giving you bronchodilators, a nebulizer treatment, they're looking to see, are there any things that's going wrong with your blood pressures, with your other diabetes medicines? We can do all of that, and if I feel, hey, this guy really needs to go to the hospital, I can call my counterpart in the hospital, the hospitalist. I'll tell you, a doctor to doctor talk. A one minute doctor to doctor talk is worth an hour on the computer. This is Mr. Smith. He's got a history of heart failure. He's coming in with a COPD exacerbation. We gave him a shot of sacubitril 125. I gave him a nebulizer treatment. He's still having some hypoxia. I think he's retaining CO2. I think he needs to be on BiPAP. The E.R. doctor hears that, the hospitalist hears that, and they know exactly what I'm thinking. They know exactly what we've done. So, I think seeing your primary care provider when you're having an exacerbation is immeasurably good.

CARMENN MILES
Yeah, I imagine, as a patient, I would much rather go to someone who I'm familiar with, they're familiar with me, they know my medications, and they can guide me through the process. A lot of people don't know about hospitalist. That collaborative care between your primary care physician and your hospitalist is so valuable. Dr. Pereira, once weÕve been diagnosed with COPD, what are some changes we can make in our life to continue to live well with COPD?

DR. RODRIGO PEREIRA
I think one of the things is to stay active. Sometimes the patient is so debilitated that they may need to do some rehab first. There's rehab for people with COPD. But the worst thing you can do is to stop. So, you do need to have some physical activity going. I think you need to be up to date with all the vaccines. One of the things that will cause you to have flare ups is when you get, let's say, flu, COVID, pneumonia. We have vaccines for all those things. So, being up to date with your vaccines is one of the things that you really need to do. It's always easier to deal with medical problems when you're healthy. So, if you're eating healthy, if you are physically active, it's going to be easier for your body to deal with any stress and any other conditions that you have to deal with. So, that would be my next recommendation. We talked about how smoking is the number one cause, but it's not the only cause. If you have a type of work or if you have exposures that can compound on the effect of the COPD, maybe that's not the best job for you if you're exposed to chemicals and fumes and dust particles. You might need to reassess that as well.

CARMENN MILES
You talked about staying active. When you're suffering with COPD, how do you know what's enough in terms of activity in terms of breathing and all those things? How do we know how much activity is enough? Is there a way to determine that?

DR. RODRIGO PEREIRA
From a patient that has mild COPD, it really is what is your comfortable doing. You don't of course want to push somebody that has not been exercising for a long time. I think the challenge becomes the patient that gets short of breath, at rest or with minimal effort. That is the patient that I wouldn't say just go out and go for a jog. That's the patient I would say, you know what, we need to start you on rehab so then they can monitor you as you do the exercises to find out what's safe for you to do when you're by yourself.

CARMENN MILES
Very good. Any last words, Dr. Seudath, before we sign off already?

DR. RAJAY SEUDATH
No, I think, definitely doing some deep breathing exercises. The vaccines are amazingly good. So, if you're going to get sick, you'll will have less symptoms if you're vaccinated. So, get your vaccines.

CARMENN MILES
Absolutely. Thank you, Docs. We are out of time. Thank you both for sharing your expertise today. Thank you to our listeners who join us each week as we explore ways to live healthier lives. Remember, you can listen to Docs in a Pod wherever you get your podcasts, and you can also catch us on the radio in several Texas and Florida markets. Until the next time, thanks for joining us and stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

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