Speaker 03: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden, primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare, and what matters to you. And now here's our host, Dr. David Hilden.

Speaker 00: 0:18

Hey, everybody, and welcome to episode 18 of the podcast. I am your host, Dr. David Hilden, and today we're tackling a topic that doesn't always make the headlines but affects millions of people every single day, that being chronic obstructive pulmonary disease, or COPD. Okay, if that sounds like a mouthful, don't worry. We're going to break it all down. Whether you've heard the term before or it's brand new territory, by the end of this episode, you're going to be breathing just a little bit easier knowing what it is, how it shows up, who it affects, how it's treated, and most most importantly, how you can help prevent it. To help make us a little wiser on the subject, I've got a terrific guest joining me today, Dr. Caroline Davis. She is a pulmonologist who has seen it all when it comes to lung health. Caroline, welcome to the show.

Speaker 02: 1:00

Hi, thanks for having me.

Speaker 00: 1:01

What's a pulmonologist? I mean, I kind of know, I do, but could you help us out? What exactly is a pulmonologist?

Speaker 02: 1:06

A pulmonologist is a lung doctor, someone that sees people who have trouble with their breathing or trouble with cough, issues with their lungs.

Speaker 00: 1:13

And that's what you do? That's what I do. And you also do intensive care, right?

Speaker 02: 1:16

I do, yes. So I work in the intensive care unit where we care for people that need life support.

Speaker 00: 1:21

Is that always the case that the intensive care doctors are also lung doctors? Because most of them are here.

Speaker 02: 1:26

Yeah, not always. I think it's usually linked together because of the need for the breathing machine, the ventilator, which is a form of life support that we use all the time in the ICU.

Speaker 00: 1:36

Got it. Okay, so we've got a lung doctor here with us to talk about lung disease. Start with the basics, if you could, in simple terms. What is COPD?

Speaker 02: 1:44

So COPD is a disease of the airways where people develop difficulty getting all of the air out of their lungs. And it's defined by, characterized by shortness of breath that gets worse with exercise and gets worse over time.

Speaker 00: 1:59

That doesn't sound so scary. They can't get the breath out. Why is that a problem?

Speaker 02: 2:04

Yeah, great question. So if you can kind of imagine breathing through a straw, at first you might be able to kind of take big, deep breaths, but eventually it takes so long to get the air out that you can't get enough air in anymore. and your lung volumes actually go down.

Speaker 00: 2:19

So why does that happen?

Speaker 02: 2:20

It happens because there's destruction of the tissue that supports the airways, that keeps it open. And so those airways, they collapse when you're trying to breathe out.

Speaker 00: 2:28

So many people don't know that your lungs aren't just big balloons, but there are all kinds of little tissue in there and they've got all kinds of surface area in there. They're not just open. So in COPD, is it the lung tissue itself that's the problem or is it the airways?

Speaker 02: 2:41

So if you think about your lungs looking like an upside down tree, Trachea, your windpipe, is like the trunk of that tree, and then your airways branch out as the branches of the tree. Now, on the ends of the tree are the leaves, but in your lungs, there are these little bubbles called alveoli, and they help you absorb oxygen and get rid of carbon dioxide. The disease COPD really affects the airways, the branches of that tree, but it's often associated with emphysema, which is where there's destruction of the bubbles, the alveoli, and so it can, in some ways, affect both things.

Speaker 00: 3:13

I think that's a term people maybe know, emphysema. So let's talk about the types of COPD, emphysema being one of them. Could you say more about that one? What does it look like? Why is it a problem? And frankly, what causes it?

Speaker 02: 3:25

Yeah, I think the way that the guidelines and I think about COPD is that COPD is really the trouble with getting the air out. And it is associated with emphysema, but you can have emphysema without having COPD. So emphysema is when there's loss of some of those alveoli, some of those bubbles, and they make these basically larger bubbles in your lungs. And then you can't absorb as much oxygen. You can't get rid of as much carbon dioxide. Whereas COPD is really just the problem with the airways themselves.

Speaker 00: 3:51

So you've got these in emphysema, you've got these Bigger chunks of lung tissue, big holes in there. I always think of it as like somebody, a mouse, not somebody, but a mouse or something chewed out the things and you've got bigger holes, not just these little teeny small ones.

Speaker 02: 4:03

Yes, that's what it looks like on a CT scan. It kind of looks like cobwebs, like spider webs.

Speaker 00: 4:07

Yeah, so what causes that?

Speaker 02: 4:09

Yeah, so the most common cause of emphysema is by and large going to be smoking. And really it's a lifetime of smoking that usually causes it.

Speaker 00: 4:16

So we got a lung doctor to say smoking's bad, but it took you five minutes. One of the things, this is a little aside, but one of the things on this podcast, we've done dozens, hundreds of episodes, and smoking comes up a lot. And I guarantee you, listeners, smoking is going to be a problem for many of the things we are talking about today. So smoking causes emphysema. Do we know why it does that?

Speaker 02: 4:38

So smoking and really inhaling something that is combusted into your lungs causes problems with the airways because it destroys the part of your airways that helps get rid of stuff like pus from an infection. It also just directs I think

Speaker 00: 5:00

we can safely say don't put something that's on fire into your mouth if you can help

Speaker 02: 5:05

it. 100%. Yeah,

Speaker 00: 5:06

so that's our smoking public service announcement for the day. So that's emphysema. Talk about some of the things that can happen in COPD then with the airways.

Speaker 02: 5:16

So COPD, we usually kind of think about a few different things that is associated with COPD. One is it causes breathlessness with activity. It's often associated with chronic bronchitis, which is where there's swelling and mucus production in the airways that makes people cough and have a productive cough, meaning they're bringing stuff up when they cough. People often experience chest tightness and chest congestion along with these things.

Speaker 00: 5:40

Are these also related to smoking or are there some other causes for chronic inflammation in the airways?

Speaker 02: 5:46

Well, I think usually COPD... Chronic bronchitis, emphysema are associated with smoking. 75% of the cases of COPD in the United States are caused by smoking. Other things that can cause COPD are longstanding asthma, exposure to biomass fuel, so like cooking with carbon-based fuel sources, including like coal or wood, can cause COPD. There's also a number of genetic factors, and premature birth can lead someone to get COPD.

Speaker 00: 6:18

I remember I did have an adult male patient who had really bad emphysema and it was from a genetic factor. So it's not just smoking and all these other things. There are some other causes of that. You did mention asthma and I'm going to put a placeholder in that because asthma is a form of obstructive lung disease and it's so common. So I want to come back to that and focus on asthma. But before I do that, how common is COPD generally in the country?

Speaker 02: 6:41

Yeah, in the country, about 6.5% of people have physician diagnosed COPD.

Speaker 00: 6:47

That's a lot.

Speaker 02: 6:47

That's a lot. Yeah, it's very common.

Speaker 00: 6:49

It's way more than I thought, actually.

Speaker 02: 6:50

And in the world, it's 10%. Is

Speaker 00: 6:51

that because of biofuels and things in the world, do you think, or more smoking?

Speaker 02: 6:55

Both. Depends on the country. So if you, like a low- and middle-income country where people tend to use carbon-based fuel sources, again, that's wood, charcoal, for cooking, those countries have more biomass fuel-related COPD.

Speaker 00: 7:10

Is it more common at certain ages or other demographics?

Speaker 02: 7:13

Definitely. It's way more common after the age of 50. And it's much less common in younger people.

Speaker 00: 7:19

Yeah, I haven't seen too many younger folks, 20, 30-year-olds with COPD, except asthma. We're going to come back to asthma. Yeah, asthma's important. Do you think it's on the rise? Is it about the same? Or what do you think in your practice? Is it getting more and more of it? Or how are we doing?

Speaker 02: 7:33

So in the United States from 2011 to 2021, the percentage of people with COPD stayed the same, didn't change. That being said, we've got a couple of factors that are affecting how people are presenting, which is that smoking has gone down among young people, 18 to 44. So those, we see fewer patients like that. And we see more patients over the age of 75 with COPD.

Speaker 00: 7:54

Yeah. And who knows what those 18 to 44 year olds who aren't smoking as much, but might be vaping and some other things, who knows what that's going to look like?

Speaker 02: 8:02

Yes. I mean, vaping has been associated with development of COPD, but not to the same extent as cigarette smoking.

Speaker 00: 8:09

Right. Okay. Let's talk about the individual who has COPD. What kind of symptoms do they have? What does it look and feel like?

Speaker 02: 8:16

People with COPD, experience shortness of breath, especially with activity. They also can experience chest tightness, chest congestion, where they feel like there's stuff in their chest that they can't get up, sputum production, cough.

Speaker 00: 8:27

That could be from a lot of things, doctor.

Speaker 02: 8:29

It could indeed. Yeah. There's a lot of overlap with COPD with other diseases, in fact. And many people with COPD have more than one thing. So it's important to get evaluated.

Speaker 00: 8:38

How do you diagnose it then? So somebody comes in, they've got that. I'm having trouble breathing, doc. What do I do? Or what do you do?

Speaker 02: 8:43

So I start with taking a really good history to kind of understand when you you have symptoms and if they come and go or if they're constant and getting worse, I ask people about everything they've inhaled because previous exposures to things that you've inhaled can cause lung disease. I also do an exam to look for wheezing or taking a long time to exhale. And then we do lung function testing where we test how big of a breath you can take and how quickly you can get the air out. And that's really very important for the diagnosis of COPD.

Speaker 00: 9:13

You mentioned wheezing. And for listeners out there, that's when your airways kind of collapse. And it's more of instead of just a nice, calm breath going in and out, there's a little high-pitched or low-pitched. There's an extra sound on that. What causes wheezing? And does the patient know they're having wheezing?

Speaker 02: 9:28

So the reason for the wheezing is it's really a multi-tone sound. We call it polyphonic sound that we hear when someone is exhaling when we listen with a stethoscope. Wheezing is caused by the small airways, those small branches on that tree that are narrowed. And so you hear that kind of whistle sound with the air moving through the airways on exhalation.

Speaker 00: 9:50

Okay, everybody, you can say polyphonic. Wheezing is a type of polyphonic sound. Yep.

Speaker 02: 9:56

Because you hear multiple tones. So does the patient know that they're wheezing? Sometimes they do, because sometimes you can kind of feel it, and sometimes you can hear kind of loud wheezing. But most of the time, the patient doesn't know that they're wheezing, and we just hear it when we're listening with the stethoscope. When people can hear it, it's usually more affecting the large airways.

Speaker 00: 10:16

Do you have to do other diagnostic tests then after you've visited with a patient, you've done all this history, you've listened to them? Are there other diagnostic tests you usually do?

Speaker 02: 10:24

Yes. So I think the other things that are really important are considering imaging, so x-rays or CTs, depending on the patient, CAT scans, and then blood tests to help figure out what kind of inflammation they may have in their blood.

Speaker 00: 10:37

So earlier you mentioned asthma, and asthma is huge. And listeners, I would refer you back to an earlier episode in a previous season with Dr. Josh Dorn. We talked a little bit about asthma, but I've never talked to a lung doctor. He was an allergist. I've never talked to a lung doctor about asthma. Now that is something that kids have and young adults have. What is asthma? Yeah, I

Speaker 02: 10:58

think it becomes a little easier to understand if we kind of compare it directly to COPD. So COPD is trouble getting all the air out that gets worse slowly over time. It's progressive. It's always there. It gets worse. Asthma causes variable troubles with getting the air out.

Speaker 00: 11:13

So you'll get kids, young adults, older adults with asthma who will only get their symptoms at certain times like... before exercise or when it's really cold outside or when their allergies act up, right?

Speaker 02: 11:24

Exactly. Asthma is a disease of both inflammation and hyperreactivity to something that's in their environment, something that they inhale.

Speaker 00: 11:30

But they still have trouble getting air in and out, right?

Speaker 02: 11:32

They do. And they really show the same things on their lung function testing, which is trouble getting all the air out. The difference is that with asthma, we see an improvement back to normal with inhalers, whereas with COPD, we don't see an improvement back to normal with

Speaker 00: 11:46

inhalers. So we're talking with pulmonologist Dr. Caroline Davis all about chronic obstructive pulmonary disease, or COPD. When we come back from a short break, we're going to talk about what it's like to live with the condition, available treatment options, and how you can avoid COPD altogether. So stay tuned. We'll be right back.

Speaker 01: 12:06

When Hennepin Healthcare says, we're here for life, they mean here for you, your life, and all that it brings. Hennepin Healthcare has a hospital, HCMC, a network of clinics in the metro area, and an integrative health clinic in downtown Minneapolis. They provide all of the primary and specialty care you'd expect to find, as well as services like acupuncture and chiropractic care. Learn more at hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 00: 12:43

And we're back talking about COPD with Dr. Caroline Davis. She is a lung doctor, otherwise known as a pulmonologist. Caroline, can you tell us what's it like for a person to live with COPD?

Speaker 02: 12:53

I think it's a challenge. You know, it's really hard to live with breathlessness. And some people with COPD, they really struggle to feel confident going outside because they always have to plan for when they have to take a break because they're short of breath.

Speaker 00: 13:04

So somebody who's got a significant COPD, a symptomatic then, what does their daily life look like? How do they get through the day? Do they have to carry oxygen tanks? Do they take their inhalers? What does it look like?

Speaker 02: 13:16

Well, boy, it really depends on how bad the COPD is. If it's mild, they might not really notice that much impact on their daily life. Whereas if they have moderate or severe COPD, they might have to plan to be able to have a place to sit down when they're feeling short of breath. They might only be able to walk one block without having to stop and rest.

Speaker 00: 13:33

You mentioned something earlier that it It's a little sobering if you think about it that it's a progressive disease. Are there things people can do to slow down the progression?

Speaker 02: 13:42

Yeah, great question. So I think COPD I think about as a kind of premature aging. Everyone's lung function kind of decreases with time. All of ours does, right? Everyone, yep. You and me right now. Yeah. Lung

Speaker 00: 13:54

function. By the end of this podcast, we'll have lost a little. No, seriously. Seriously, Caroline. Remember in med school when you were first learning about flow loops? This is all lung function. They draw these graphs and they show the decline of lung function for everybody. And it's like depressing as all heck because eventually- that line hits the bottom and then you're kind of done.

Speaker 02: 14:15

Well, if we all live to be 200, then yes.

Speaker 00: 14:17

Yeah, exactly. So this lung function declines, but in COPD, seriously, it does decline faster and they show us that line too. It gets us a steeper line. So what things can people do or are things people can do to make it worse or make it better?

Speaker 02: 14:32

Well, gosh, number one, two, and three is quitting smoking or don't smoke. Those are the most important things.

Speaker 00: 14:38

It's never too late to do that. You might not reverse the damage that It's already been done, but you can prevent it from getting worse.

Speaker 02: 14:45

You can prevent it from getting worse. And a lot of people with COPD who are smokers have asthma because they're inhaling something that their lungs don't like every day, cigarette smoke. And so they might even feel better as far as their breathing as soon as they quit smoking.

Speaker 00: 14:58

Okay, so that is the first several bits of advice if you happen to smoke. What if you don't or you're working on that? And folks, don't beat yourself up for that. It's hard to do. You need to, you can, and you should quit smoking.

Speaker 02: 15:10

I'm obviously really passionate about this because I'm a lung doctor, but quitting smoking is super hard. And most people, you know, they have to quit seven times before they eventually are able to kind of kick the habit. And so I really feel like using tools to help you quit smoking is really important. And your doctor has a lot of tools to help you quit smoking. And that includes nicotine replacement, as well as medications to help reduce cravings. And so thinking about using all the tools in your toolbox to help quit smoking is really important.

Speaker 00: 15:37

What else can people do?

Speaker 02: 15:38

So I think if you have asthma to get treatment for your asthma, There's a lot of treatments for asthma that can really reduce the progression and help you feel better and not have flares. Preventing respiratory infections, especially in childhood, is an important method to help prevent.

Speaker 00: 15:53

Why especially in childhood?

Speaker 02: 15:54

Your lungs are still developing. Really, they're developing into adulthood. And so in order to kind of protect your lungs when they're just developing, when they're starting to kind of develop all those little airways, it's really important to prevent bad infections.

Speaker 00: 16:06

Yeah, that makes sense. That makes sense. And as an older adult, get your vaccines against pulmonary infections, right?

Speaker 02: 16:11

Oh, 100%. Yeah, that's a huge factor in death from COPD and in preventing the progression is to get regular vaccinations for respiratory diseases, especially.

Speaker 00: 16:22

And there's lots of them, folks. We've been talking about that, oh, for years and years. But in the year 2020, we really talked about it. And we're still talking about it today is get your vaccines is still the best way to prevent some of those respiratory infections.

Speaker 02: 16:34

And the vaccines that we recommend are vaccines against COVID-19, against influenza. Those are every year, as well as vaccines for pneumonia Tdap, which includes pertussis, which is a respiratory infection. Whooping cough, yeah. Yeah, whooping cough, yep. And RSV in people with COPD and asthma ages 60 and older.

Speaker 00: 16:51

Okay, so that's really good advice. Okay, so I'm doing all that. I'm trying to quit smoking, or I have. And I'm getting my asthma under control. I'm doing my best to keep my lungs healthy with my vaccines and helping my kids stay healthy with lung diseases. I'm doing all that. Is there anything else I can do in my daily life?

Speaker 02: 17:08

Yeah, I honestly think one of the most important things to protect your whole body especially when you have lung disease or even if you don't is regular physical activity I can't make the numbers on your lung function better with COPD most of the time. But what I can do is help people feel better and help people live longer by getting regular activity.

Speaker 00: 17:27

So let's talk about treatments and cures. Is there a cure for COPD?

Speaker 02: 17:31

There's not a cure, but there's lots of treatments to help manage it. There are two things that we really aim for when we're trying to treat COPD. One of them is to reduce shortness of breath, and the other thing is to reduce risks. So to reduce shortness of breath, we think about inhalers to help open up the airways. We think about pulmonary rehabilitation Which is a program... where people, it's both a combination of an educational program and a monitored exercise program so that you can work on breathing techniques to help with breathing when you're feeling short of breath and work on getting more physical activity to help strengthen your heart and your muscles so you can go out and do more.

Speaker 00: 18:07

Before you move on from pulmonary rehab, it's something that when I have a patient who's done it, I'm always glad they did it. But I don't think enough people know about it. Where does one access a pulmonary rehab

Speaker 02: 18:17

program? So there's a number of pulmonary rehab programs at many major hospitals. And so I You can access it by talking to your doctor about pulmonary rehab. And I bet anyone would be really happy to refer you because it's a great program, very low risk, and helps people gain a lot of confidence.

Speaker 00: 18:31

Yeah, it really is. What about all these things that people are inhaling and, I might add, are endlessly advertised?

Speaker 02: 18:37

Oh, yeah. So there's a number of different inhalers. I think the important thing with COPD these days is that the treatment is personalized. And so how we treat it depends on you and your profile, and that includes blood tests, imaging, and your symptoms. So we use inhalers. We use inhalers to help open up the airways. We use inhalers to help take down inflammation, an inhaled steroid. And those are kind of the, these are the mainstay, the kind of backbone of COPD treatment.

Speaker 00: 19:01

Steroids, that's a word that sometimes freaks people out. So what does an inhaled steroid

Speaker 02: 19:05

do? Many people with COPD have inflammation, swelling in their airways that's going to cause some of that mucus production and cause those airways to be smaller anyway. And so the steroids help with that inflammation. They take it down. But steroids are complicated in COPD. For some people, they make things worse. Because if they don't have a lot of inflammation, then the steroid in someone that has a higher risk for infection can actually increase your risk of infections. And so it's really important that your doctor carefully considers, is it time to do a steroid or is it not?

Speaker 00: 19:34

Yeah, I think that's a really good point because we've said that there's a couple things that lead to COPD. One of them is inflammation, but it's not the only thing.

Speaker 02: 19:42

So the other thing that I want to say about inhaled steroids is that the risk is lower when you inhale a steroid than when you take it by mouth. However, the reason why we worry about it so much in COPD is because the tissue of the lung is not working properly. And so people with COPD are more likely to get infections. And so for them, using an inhaled steroid is more risky than in using it with someone with asthma,

Speaker 00: 20:05

inflammation. Okay. What about then, as long as we're on the topic of steroids, there are steroids that come in pill form and other forms. When do people need to take something like prednisone?

Speaker 02: 20:15

So prednisone is a steroid pill that we use in patients with COPD when they have a flare, an exacerbation. An exacerbation is when someone has kind of a quick... increase in shortness of breath. Sometimes they have more mucus production. Sometimes their mucus changes color. And in those patients, they need a short course of prednisone to help them get over their symptoms and feel better.

Speaker 00: 20:37

Okay, so there are some inhalers, inhaled corticosteroids, systemic or pill form steroids. There's other meds in those inhalers too. A lot of these inhalers have two or three things in them. Without getting into the nitty gritty details of those other medications, how do those combination things work?

Speaker 02: 20:54

Because COPD is primarily the problem is getting the air out the mainstay of treatment is really inhalers that help open up the airways and there's an alphabet soup of different inhalers but for most people with COPD who have symptoms we give them an inhaler that's a combination of two different medications that work all day and help to open up the airways

Speaker 00: 21:16

Okay, so Dr. Davis, what else? You've got inhalers. We've talked about prednisone.

Speaker 02: 21:19

So in people that have a lot of symptoms or have frequent exacerbations where things get worse and they need to take prednisone, we think about more advanced therapies depending on that patient and their profile. So sometimes we think about using injectable medications just like we use for asthma and COPD for people that have a lot of inflammation.

Speaker 00: 21:41

At this point, when people are needing these medications, are they usually seeing you? Are they seeing a pulmonologist by this point?

Speaker 02: 21:47

Yes, 100%. Because

Speaker 00: 21:48

I haven't touched on that earlier. Folks, you can go to your primary care physician or other clinician when you're starting to have some symptoms. But when we're starting to talk about injectable medications and some of the more challenging inhalers and the like, it's time to see a pulmonologist.

Speaker 02: 22:02

Yeah. If you're on inhalers, the long-acting inhalers, and you're still having symptoms, and especially if you're having flares that are bringing you into the hospital or bringing you into the ER, that's when you should see a pulmonologist.

Speaker 00: 22:13

Yeah, I'm hoping that people get that message Go see a lung specialist when you're getting into this stuff.

Speaker 02: 22:18

Yeah, and I think so the injectable medications are one thing we use. We also sometimes, for some people, think about lung volume reduction like a surgery.

Speaker 00: 22:27

Lung volume reduction. Okay, sign me up for that. Why don't you take a chunk of my lung there, doctor? Seriously? Can you say some more about lung volume reduction? You only have five lobes. And I know I'm a general internal medicine doctor. I'm not a lung doctor, but I am aware there are five lobes, three in one lung and two in the other. You take them out?

Speaker 02: 22:49

Yes. The idea behind this is sometimes people have such damaged lungs and it's often at the top of their lungs that the rest of their lung, the lung that's mostly functional, can't work at all and is totally squished. because the air in the top can't get out. And so sometimes we talk about taking out that piece of the damaged lung in order for the rest of the lung to re-expand and be able to work better.

Speaker 00: 23:11

That does make some sense, because as we talked earlier in the show, this is a problem of getting air out. Emphysema is a problem of destruction of the alveoli into bigger holes, and so air gets trapped in and lungs get big. It just kind of does sound kind of funny. So you've got a lung disease, so let's take part of it out.

Speaker 02: 23:28

I know. It's really weird. I

Speaker 00: 23:29

bet that's when it's getting pretty serious.

Speaker 02: 23:31

That's when it's getting very serious.

Speaker 00: 23:32

When do people need oxygen?

Speaker 02: 23:35

Yeah, so people need oxygen when the oxygen levels in their blood drop down below a specific level. And so it's not just for shortness of breath. The oxygen doesn't necessarily help with shortness of breath unless the shortness of breath is from low oxygen. You can be short of breath and have totally normal oxygen levels.

Speaker 00: 23:53

That's kind of an interesting point. So it literally is just used when the oxygen levels are too low to sustain you at a healthy level.

Speaker 02: 24:01

Exactly. And some people need oxygen when they're having a flare in the hospital and they don't need it when they go

Speaker 00: 24:05

home. Okay. So you might need oxygen, but that's sort of we're talking about in a specific situation. It's very much based on your oxygen levels, not for your symptom control. Is that correct?

Speaker 02: 24:14

That's correct.

Speaker 00: 24:15

Okay. Terrific. So people with lung disease and trouble breathing often have a complex collection of things. They might have asthma. They might have allergies. They might be a smoker. They might have emphysema. All these things. How do you sort all that out when someone comes in to see you?

Speaker 02: 24:31

This is why we have to collect a good history and why we get testing to confirm the diagnosis. And so it's really important to see your doctor if you're having other symptoms. There is a significant overlap with asthma and COPD. And therefore, there's also an overlap with allergies because allergies really overlap with asthma and allergies can cause asthma. And so getting an evaluation to see if you have inflammation from allergies and from asthma can help determine if you might benefit from certain medications that we use to treat COPD and prevent exacerbations. The other things that people with COPD tend to have, especially in people that are current or former smokers, is heart disease. And so it's really important for your doctor to kind of think about, oh, are they symptoms from heart disease or are they from COPD, and to do testing to make sure that they know.

Speaker 00: 25:20

Good tips, because not everything in the human body is simple in just one little thing. Sometimes you have to manage a number of what we call comorbidities. That's the medical term for all of your medical problems. Yeah. Can I ask you to predict the future a little bit, or at least when you are going to your lung conferences or talking with other people in academic medicine and pulmonology, what is the future maybe looking like for either therapies or diagnoses for COPD?

Speaker 02: 25:45

Well, I think we're really moving into an era of personalized medicine. And I've alluded to this a couple of times earlier in our conversation, which is that we use really advanced techniques in getting laboratory data. There are new techniques using CT scans to help really see exactly what's wrong with the lungs. And I think we'll see more of that using this very specific personalized data to guide how we treat people to reduce risk. The other thing that I see coming down the pipeline is that there's been a lot of advancements in how we treat asthma. Because asthma is a disease of inflammation. And I see that a lot of those treatments are also becoming relevant to COPD or being tested for patients with COPD to see if it can help reduce flares and help people feel better.

Speaker 00: 26:30

Before I let you go, I want to one more time talk about prevention and staying healthy. What advice would you give to people? I think I know what the main one might be, but I want you to say it again.

Unknown: 26:43

Okay.

Speaker 02: 26:43

Yes, you know what the main one might be, which is quit smoking or don't start smoking. I think the other things that I think are super important is, again, treating asthma, getting regular physical activity, preventing infections. And the other thing is you can prevent your children from getting COPD if you get regular vaccinations and prenatal care in pregnancy. It's worth it to get evaluated for COPD because we can help you feel better, we can reduce progression of disease, and we can help you live a more independent life. And so I think that's important. Dr.

Speaker 00: 27:14

Caroline Davis is a pulmonologist at Hennepin Healthcare in downtown Minneapolis. And one of my colleagues here, thank you so much for being on the show, Caroline.

Speaker 02: 27:21

Oh, thank you for having me. It's been great.

Speaker 00: 27:23

Listeners, lots of good tips here for you. And if you are having symptoms, please do seek out attention with your clinician. And I hope you'll join us for our next episode in two weeks' time. And in the meantime, be healthy and be well.

Speaker 03: 27:35

Thanks for listening to the Healthy Matters Podcast with Dr. David Hilden. To find out more about the Healthy Matters Podcast or browse the archive, visit healthymatters.org. Got a question or a comment for the show? Email us at healthymatters at hcmed.org or call 612-873-TALK. There's also a link in the show notes. The Healthy Matters podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota, and engineered and produced by John Lucas at Highball. Executive producers are Jonathan Comito and Christine Hill. Please remember, we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.