♪ >> GOOD EVENING AND WELCOME TO DOCTORS ON CALL.

I'M DR. RAY CHRISTENSEN, FACULTY MEMBER IN THE DEPARTMENT OF FAMILY MEDICINE AND BIOBEHAVIORAL HEALTH AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL HERE IN DULUTH.

I AM ALSO A FAMILY PHYSICIAN AT THE GATEWAY FAMILY HEALTH CLINIC IN MOOSE LAKE.

I AM YOUR HOST FOR TONIGHT'S PROGRAM ON "ALLERGIES, ASTHMA, COPD AND LUNG PROBLEMS."

THE SUCCESS OF THIS PROGRAM IS DEPENDENT ON YOU, OUR VIEWERS.

PLEASE CALL OR EMAIL YOUR QUESTIONS AND WE WILL DO OUR BEST TO ADDRESS THEM.

THE TELEPHONE NUMBERS AND EMAIL ADDRESS FOR YOUR QUESTIONS CAN BE FOUND AT THE BOTTOM OF YOUR SCREEN.

OUR PANELISTS THIS EVENING ARE: DR. WAYNE ELMER, A PULMONOLOGIST WITH ST LUKE'S PULMONARY MEDICINE ASSOCIATES.

AND DR. JASON WALL, A FAMILY MEDICINE PHYSICIAN WITH ESSENTIA HEALTH AND FACULTY MEMBER AT THE DULUTH FAMILY MEDICINE RESIDENCY PROGRAM.

MEMBERS OF THE WDSE STAFF ARE STANDING BY TO TAKE YOUR PHONE CALLS.

AND NOW ONTO TONIGHT'S PROGRAM.

WELCOME BOTH OF YOU, IT IS GOOD TO SEE YOU HERE.

JUSTIN, YOU ARE WITH FAMILY PRACTICE MEDICINE.

-- WHAT ARE SOME ALLERGIES THAT ARE CONSIDERED SEASONAL?

DR. WALL: THANK YOU, DR. CHRISTIANSEN.

SEASONAL ALLERGIES SOMETIMES, ESPECIALLY NOW WITH COVID, WHEN WONDERING ARE YOU SICK FROM COVID OR, AND MANY OF MY COLLEAGUES HAD MADE IT CLEAR THAT THEY SUFFER FROM SEASONAL ALLERGIES AND YOU SEE A PEAK IN THIS SPRING AND FALL.

THERE IS MORE POLLEN IN SPRING AND INVOLVE THERE IS A LOT OF GRASSES THAT ARE BLOOMING AND ADDITIONAL ALLERGENS IN THE AIR.

WITH THE DEBUT OF SPRING AND WARMER WEATHER, PEOPLE ARE OFTEN PRESENTING TO THE CLINIC AND SOME OF THE COMMON ADVICE WE GIVE THEM IS TO -- IF YOU CAN MAKE SURE THAT YOU WASH YOUR FACE, RINSE OUT YOUR SINUSES, SHOWER DAILY, THAT CAN HELP DECREASE THE AMOUNT OF ALLERGEN YOU INHALE INTO YOUR UPPER AIRWAYS IN YOUR EYES.

ALSO SPENDING TIME INDOORS IN AN AIR-CONDITIONED OR VENTILATION SYSTEM WITH AN AIR EXCHANGER AND THAT WILL OFTEN FILTER OUT SOME OF THE ALLERGENS.

THAT IS A BASIC APPROACH, MINIMIZING YOUR EXPOSURE AND RINSING AWAY ANY ALLERGENS.

ADDITIONALLY, A NONPHARMACOLOGIC APPROACH IS RINSING OUT YOUR SINUSES EVERY DAY WITH THE DUTCH A SALINE SOLUTION, PEOPLE USING NETTY POT.

WE HAVE A VARIETY OF OVER-THE-COUNTER AND PRESCRIPTION MEDICATIONS THAT CAN BE USED FOR SEASONAL ALLERGIES, AND THE BASIC APPROACH, MANY OF THE ANTIHISTAMINES, THEY ALL HAVE TRADENAMES OVER-THE-COUNTER.

IT WILL TAKE AWAY THE SYMPTOMS BUT THEY HAVE A DRIVING EFFECT.

ANOTHER AND PERHAPS THE MOST EFFECTIVE IS A NASAL STEROID, YOU CAN USE TWO SQUIRTS OF THIS NASAL STEROID.

THE MOST COMMON WHEN YOU CAN GET OVER-THE-COUNTER FROM YOUR PHARMACY, ALSO PRESCRIPTION.

THERE ARE ALSO ANTIHISTAMINE EYEDROPS.

THAT IS A NICE OPTION FOR PEOPLE WHO HAVE ITCHY EYES BUT DON'T WANT THE EFFECTS OF TABLETS.

WE RECOMMEND STICKING WITH A NASAL STEROID BECAUSE THAT DECREASES A LOT OF INFLAMMATION, THE DRAINAGE, AND THE ITCHING.

IT DOES NOT WORK OVERNIGHT BUT IT IS EFFECTIVE.

DR. ELMER: I WOULD LIKE TO ADD A COMMENT TO WHAT JASON SAID WHICH IS THAT THE STEROIDS AND FRONTLINE THERAPY, BUT THE COMMON MISTAKE PEOPLE WILL MAKE WHEN USING THE NASAL STEROIDS IS TO TRY THEM FOR A DAY OR TWO AND NOT NOTICE MUCH AFFECT.

SO THEY MAY ABANDON THE TREATMENT EARLY ON.

THIS IS A CRITICAL STEROID, IT IS AN ANTI-INFLAMMATORY AND SO OFTEN -- IT IS A CORTICAL STEROID, IT IS ANTI-INFLAMMATORY AND THE REACTION IS DELAYED.

IF YOU FIND OVER-THE-COUNTER NASAL SPRAY, USUALLY IF YOU DO TWO SNIFFS A DAY THERE'S ENOUGH MEDICINE TO LAST YOU TWO WEEKS AND I ENCOURAGE PATIENTS IF THEY ARE GOING TO DO THAT TO USE -- A FULL TWO WEEKS BEFORE DECIDING IF IT IS HELPING OR NOT.

OFTENTIMES IT IS A STEPWISE APPROACH, IF YOU ARE USING THE SPRAY BUT STILL HAVING A SYMPTOMS -- SYMPTOMS, RATHER THAN ABANDONING IT AND TRYING SOMETHING ELSE, STAY ON THE NASAL SPRAY AND TRY ANOTHER ANTIHISTAMINE.

PENDING ON HOW STIRRED UP YOUR ALLERGIES ARE, THE COMBINATION OF THE TWO MAY GIVE YOU BETTER CONTROL THAN USING EITHER ONE INDIVIDUALLY.

DR. WALL: -- DR. CHRISTENSEN: JUSTIN, I APPRECIATE HOW YOU TOOK THAT ON.

NICE JOB, BOTH OF YOU.

LET'S GO INTO LUNGS NOW, WHAT HAPPENS WITH ALLERGIES AND LUNGS?

DR. WALL: SO PEOPLE CAN HAVE A BROCADED -- BRONCHITIS LIKE EFFECT, THAT ROUTE FIRST TWO -- THAT REFERS TO THE LOWER LUNGS.

OFTEN PEOPLE GET THE UPPER RESPIRATORY EFFECT, ITCHY WATERY EYES, BUT SOMETIMES A TRIGGER FOR LOWER RESPIRATORY SYSTEMS AS WELL.

THE CLASTIC -- CLASSIC SYMPTOMS WERE BRONCHITIS WOULD BE A PRODUCTIVE COUGH, OFTENTIMES A SENSE OF CHEST CONGESTION.

AND SO THE TREATMENT FOR BRONCHITIS, STARTING WITH, ESPECIALLY IF YOU ARE HAVING UPPER RESPIRATORY SYMPTOMS THAT'S A GOOD PLACE TO START.

MAYBE LOAD -- NOTICE SOME RELIEF FOR THE LOWER RESPIRATORY SYMPTOMS BY TREATING THE UPPER RESPIRATORY SYMPTOMS.

IF SYSTEMS -- SYMPTOMS DON'T IMPROVE WITH TREATMENT WITH ALLERGIES, THAT MAY TAKE A DIFFERENT TYPE OF THERAPY INVOLVING AN INHALED STEROID INTO THE LOWER RESPIRATORY TRACT RATHER THAN THE NASAL PASSAGES.

DR. CHRISTENSEN: WILL ALLERGIES STIMULATE ASTHMA?

DR. WALL: IT IS A TRIGGER.

SOME PEOPLE THINK THEY'RE THE SAME THING BUT PEOPLE CAN HAVE ALLERGIES WITHOUT ASTHMA OR ASTHMA WITHOUT ALLERGIC TRIGGERS THEY DO OFTENTIMES GO TOGETHER.

ANYTIME SOMEONE HAS A DIAGNOSIS OF ASTHMA ONE OF THE FIRST THINGS WE ARE LOOKING FOR IS IDENTIFYING THE TRIGGERS.

ALLERGIES ARE CERTAINLY A CLASSIC TRIGGER, CERTAIN EXPOSURE LIKE ANIMAL DANDER, ENVIRONMENTAL ALLERGIES LIKE WHEN THE PROVINCE OF ONTARIO IS ON FIRE AND WE ARE BLANKETED UNDER A LAYER OF SMOKE THAT CAN BE A TRIGGER FOR ALLERGIES.

BUT SOME PEOPLE HAVE ASTHMA THAT IS NOT TRIGGERED BY ALLERGIES.

RESPIRATORY INFECTIONS IS ANOTHER CLASSIC TRIGGER FOR ASTHMATIC SYMPTOMS.

IDR.

CHRISTENSEN: WHAT IS ASTHM?

DR. WALL: IF THIS WERE A TEST QUESTION IT WOULD BE AN AIRWAY INFLAMMATION THAT IS REVERSIBLE, THE HALLMARK IS IT IS A REVERSIBLE PROCESS AND WE HAVE A WHOLE BUNCH OF PREVENTIVE AND RESCUE MEDICATIONS TO REVERSE THE AIRFLOW LIMITATION.

I FEEL IT IS IMPORTANT THAT YEAH, THERE ARE 70 TRIGGERS FOR ASTHMA AND ALLERGIES, AND INDOOR AIR QUALITY IS A REAL ISSUE.

THANKFULLY IN MINNESOTA WE HAVE HAD SMOKING BAND IN DULUTH SINCE YOU 2000 BUT -- SO WE HAVE CUT DOWN BUT INDOOR AIR QUALITY IS AN ISSUE BECAUSE WINDOWS ARE NOT OPEN AND IF YOU HAVE PET DANDER OR MOLD, COCKROACH DANDER, THERE IS A LOT OF TRIGGERS FOR ASTHMA AND ESPECIALLY IN CERTAIN ENVIRONMENTS.

WE HAVE SEASONAL ALLERGIES BUT WE ALSO HAVE THESE YEAR-ROUND ENVIRONMENT TILL ALLERGIES THAT ARE ARE -- ARE A WHOLE OTHER ANIMAL THAT CAUSES A LOT OF SUFFERING.

ASTHMA IS IN AIR FRO -- AIRFLOW RESTRICTION TRIGGERED BY FACTORS THAT ARE REVERSIBLE.

DR. CHRISTENSEN: DO YOU USE ASTHMA CARE PLANS?

DR. WALL: TRADITIONALLY IT IS SOMETHING WE'VE ALWAYS DONE BUT WE HAVE MOVED AWAY FROM IT IN RECENT YEARS.

IF IT IS WORKING FOR PEOPLE WE CONTINUE IT BUT IT IS MUCH MORE, I THINK IN MEDICINE WE ARE TRYING TO MEET PEOPLE WHERE THEY ARE RATHER THAN BEING, THIS IS WHAT YOU NEED TO DO BECAUSE WE SAID SO.

WE ARE TRYING TO MEET PEOPLE TO WHAT WORKS FOR THEM.

IF SOMEBODY WORKS IN A JOB WHERE THEY ARE NOT GOING TO BE ABLE TO STOP AND TAKE THINGS, -- DR. ELMER: DEPENDS ON THE PATIENT.

DR. WALL: YEAH.

THE ASTHMA ACTION PLAN AS OF THE MELODY FOR EDUCATION, AS FAR AS USING IT AS DOGMATICALLY AS WE USE TO HER THEY WERE MOVING AWAY FROM IT.

DR. CHRISTENSEN: -- DR. ELMER: ANYONE WHO HAS A NEW DIAGNOSIS OF ASTHMA IT IS A GOOD THAN TO REFER TO.

IT IS A REFERENCE SO THAT IF THEY HAVE QUESTIONS THEY DON'T HAVE TO CALL THE CLINIC TO TALK TO THE DOCTOR.

BUT OFTENTIMES ASTHMA IS A MORE CHRONIC CONDITION AND PEOPLE WHO HAVE THE DIAGNOSIS AND HAVE HAD IT FOR MANY YEARS DON'T NECESSARILY NEED TO REFER TO AN ASTHMA ACTION PLAN.

BUT I THINK IT IS HELPFUL FOR NEW DIAGNOSES OF ASTHMA.

DR. CHRISTENSEN: AND FOR THE RIGHT PATIENT, IF THEY'VE HAD A LONG TIME OR HAVE ANY COGNITIVE STABILITY.

-- INHALERS, CAN YOU USE THEM TOO MUCH?

DR. ELMER: YOU CAN ABSOLUTELY OVERUSE YOUR INHALER.

IT IS A COMMON SOURCE OF CONFUSION FOR PATIENTS BECAUSE THE INHALERS MAY ALL OF THE SAME -- ALL LOOK THE SAME BUT THE NAMES MAY BE DIFFERENT.

BUT INHALERS REALLY COME IN BASICALLY FOUR CLASSES AND JASON MENTIONED EARLIER THAT ONE OF THE HALLMARKS OF ASTHMA IS INFLAMMATION OF THE LOWER RESPIRATORY TRACT AND THE FOUNDATION OF TREATING ASTHMA IS AN INHALED CORTICOSTEROID.

THERE ARE ABOUT TO DIFFERENT ONES WITH DIFFERENT NAMES BUT THE MECHANISM OF ACTION, THE EFFECT IS ESSENTIALLY THE SAME.

ANYBODY WHO HAS A DIAGNOSIS OF PERSISTENT ASTHMA, THEY HAVE SYMPTOMS MORE THAN A COUPLE DAYS A WEEK, NEEDS TO BE ON AN INHALED CORTICOSTEROID.

BUT THEN THERE ARE THREE OTHER CLASSES OF MEDICATIONS AND THEY ARE ALL RONCO DILATORS -- RONCO DILATORS -- BRONCHI DILATORS.

THEY DILATE THE BRONCHI.

THEY HAVE DIFFERENT MECHANISMS BUT THEY ALL ACCOMPLISH THE SAME THING.

PEOPLE WHO HAVE PERSISTENT ASTHMA SHOULD BE ON AN INHALED CORTICOSTEROID EVERY DAY AND DEPENDING ON HOW THEY RESPOND YOU MAY NEED TO ADD A LONG ASKING -- ACTING DILATOR WITH A GOAL OF REDUCING THE NEED TO USE THE RESCUE INHALER WHICH IS THE FOURTH CLASS OF MEDICATION WHICH WOULD BE A SHORT ACTING DILATOR.

SOME PEOPLE IF THEY ARE DOING THE EVERYDAY CONTROLLING MEDICATION WHICH CONSISTS OF AN INHALED STEROID AND A LONG ACTING DILATOR, SOME MAY GET INTO THE HABIT OF USING THE RESCUE INHALER THREE OR FOUR TIMES A DAY WHEN IT IS NOT STRICTLY NECESSARY BECAUSE THAT IS WHY YOU WANT TO GET THEM ON A LONG ACTING DILATOR TO RELIEVE THEM OF THE NEED TO KEEP USING THE SHORT ACTING RESCUE INHALER.

DR. CHRISTENSEN: SOME OF THE THINGS I'VE SEEN RECENTLY, INHALED STEROIDS HAVE BECOME FIRST-LINE BEFORE THE OTHER MEDICATIONS FOR ASTHMA.

IS THIS SOMETHING THAT YOU GUYS HAVE BEEN WORKING WITH OR NOT?

IT SEEMS LIKE ALL OF A SUDDEN THEY HAVE BEEN RELEASED FOR THAT.

DR. WALL: WHAT I HAVE SEEN IS THE MOST -- THE LARGEST CHANGE IS THE COMBINATION LONG-ACTING MEDICINE AND INHALED CORTICOSTEROID.

IN RECENT TIMES THEY FOUND THAT USING IT EPISODICALLY FOR ASTHMA DURING A SEASON WHEN YOU TURNED -- TEND TO HAVE TRIGGERS VERSUS USING IT DAILY, PEOPLE HAVE SIMILAR EFFECTS.

THAT IS FOR A MILDER FORM OF ASTHMA.

I THINK THERE IS -- IS LITERALLY COLD EXPERT PANEL -- IT IS LITERALLY CALLED THE EXPERT PANEL, A GROUP OF EXPERTS CAME TOGETHER TO TALK ABOUT THIS STEP UP AND STEP DOWN, YOU LOOK AT IT AND SAY WHERE YOU ARE AND BASED ON WHAT SYMPTOMS YOU ARE HAVING, WHETHER IT IS SYMPTOMS AT NIGHT, DURING THE DAY, HOW OFTEN YOU ARE USING YOUR RESCUE INHALER WHICH IS THE SHORT ACTING DILATOR, I STILL THINK THE WORKHORSE ARE SHORT ACTING BETA AGNES, THE CLASSIC ALBUTEROL.

BUT I AM SEEING THE CORTICOSTEROID AND THE LONG-ACTING BEING USED IN A MORE EPISODIC FASHION AND ALSO WE IN RECENT YEARS, MAYBE ABOUT FIVE YEARS HAVE BEEN USING THE LONG-LASTING -- A LONG ASKED -- A LONG-ACTING ONE AS A WAY TO CONTROL MEDICATIONS, TOO.

I THINK I WOULD LOSE OUR AUDIENCE IF I DID NOT HAVE THAT GRAPHIC BUT THERE IS A DEFINED PATHWAY FACED ON WHAT YOUR SYMPTOMS AND CERTAINLY SOME PEOPLE DO WELL ON INHALED CORTICOSTEROIDS, WE TRY TO STAY AWAY FROM THOSE IF THEY ARE NOT ABSOLUTELY NECESSARY BECAUSE THERE ARE SOME SIDE EFFECTS.

YOU CAN GET SOME BRUSH, -- THRUSH, AND THERE CAN BE IN THE YOUNGER POPULATION SOME GROWTH --IT CAN BE AFFECTED SLIGHTLY BY THAT.

DR. CHRISTENSEN: SO, AN EASY ONE, JASON.

WHAT IS THE REMEDY FOR POSTNASAL DRIP?

[LAUGHTER] DR. WALL: ONCE AGAIN, THE SHORT ANSWER IS TAKE AN INHALED NASAL STEROID THAT SHOULD DRY UP THAT INFLAMED NASAL -- IT SHOULD CROWD THE INFORMATION AND GET RID OF THE DRIP.

BUT PEOPLE CAN ALSO HAVE NASAL POLYPS, FUNGAL INFECTIONS, THERE CAN BE OTHER CHRONIC CAUSES.

EVEN PEOPLE THAT HAVE HAD PAST HEAD, CAN HAVE A CSF LEAK, LEAKING THROUGH PAST SINUS SURGERY OR HEAD TRAUMA.

YOU CAN HAVE SPINAL FLUID LEAKING AND THEY THINK IT IS A POSTNASAL DRIP.

THE SHORT ANSWER WOULD BE USE AN INHALED CORTICOSTEROID AND IF IT DOESN'T GET BETTER IT IS MAYBE WORTH DIGGING DEEPER.

DR. CHRISTENSEN: LET'S MOVE ON TO THE LUNGS, THERE'S A QUESTION FROM SOMEONE IN WISCONSIN.

WHAT ARE THE CAUSES OF NODULES IN THE LUNGS?

DR. ELMER: PROBABLY THE MOST COMMON CAUSE IN THIS PART OF THE COUNTRY IS AN ORGANISM CALLED HISTOPLASMOSA.

IT IS A FUNGUS ENDEMIC TO THE U.S., IT LIVES IN A DORMANT FORM CALLED A SPORT AND ANYONE WHO LIBERATES OUTSIDER GARDENS OR WAVES IN THE KIND OF ENVIRONMENT WE ARE IN HERE, YOU HAVE THE POTENTIAL FOR, IF THERE ARE DUSTS IN THE AIR YOU CAN INHALE LOOSE SPORES INTO YOUR LUNGS AND ONCE AGAIN INTO THE LUNGS INTO A NICE DORMER -- WARM, DARK ENVIRONMENT THEY CAN GERMINATE INTO A YEAST FORMAT IT CAN CAUSE A FUNGAL PNEUMONIA.

IT SOUNDS MORE DIRE THAN IT IS BECAUSE HISTOPLASMA IS A WEAK SISTER.

YOUR IMMUNE SYSTEM IS CAPABLE OF ENCAPSULATING THE YEAST AND WIPING IT OUT BUT IT IS NOTORIOUS FOR LEAVING THESE SMALL NODULES.

A SICKLY A SMALL DENSITY AND USUALLY THEY ARE LESS THAN A CENTIMETER AND MUCH OF THE TIME THEY ARE ON THE ORDER OF THREE OR FOUR MILLIMETERS.

IT IS A SMALL CIRCULAR SCAR AND IT IS -- FROM AN INFECTION.

THEY ARE COMMON.

IF WE DID A RAM AND -- A RANDOM SAMPLE IN THE MIDDLE OF THE PARK AND SUMMER, PROBABLY 40% OF PEOPLE WOULD HAVE A PULMONARY NODULE.

THEY CAUSE TROUBLE IS YOU CAN'T DISTINGUISH A FORMIDABLE -- FOREMAN -- FORT MILLIMETER NODULE FROM MAYBE LUNG CANCER SO THEY HAVE A DIFFERENT LEVEL OF SCRUTINY SO IF YOU HAVE BEEN 68 YEARS OLD AND YOU SMOKE A PACK OF CIGARETTES A DAY SINCE YOU WERE 17 WE HAVE THE LOOK OF THOSE MORE CLOSELY BECAUSE THE RISK OF IT NOT BEING SOMETHING BENIGN IS STATISTICALLY HIGHER.

THOSE GET SURVEILLED MORE CLOSELY.

DR. CHRISTENSEN: HOW LONG DO YOU FOLLOW THEM?

DR. ELMER: THE CURRENT STANDARD OF CARE IS WE WATCH THESE NODULES FOR TWO YEARS BUT THAT IS CONTINGENT ON OTHER QUALIFIERS BASED ON RISK FACTORS.

WHICH PRIMARILY ARE SMOKING HISTORY AND AGE.

THE SIZE OF THE NODULE AND A LOW RISK INDIVIDUAL, SAY SOMEONE LIKE JASON WHO HAS AN INCIDENTALLY DISCOVERED FIVE MILLIMETER NODULE IN HIS LUNG, CURRENT STANDARD OF CARE WOULD SAY THAT NO FOLLOW-UP IS REQUIRED.

IF IT IS AN EIGHT MILLIMETER NODULE AND SOMEONE WITH RESPECT YEARS -- FACTORS, SOMEONE OLDER WITHIN SMOKING HISTORY, THAT WILL GET WASHED FOR AT LEAST TWO YEARS.

-- WATCHED FOR AT LEAST TWO YEARS.

DR. WALL: AND THIS IS AN OPPORTUNE TIME TO TALK ABOUT AN ORGANIZATION -- THERE ARE A LOT BUT ONE IS THE UNITED STATES PREVENTATIVE SERVICES TASK FORCE AND THERE IS LOW IN CANCER SCREENING RECOMMENDED NOW FOR PERSONS AGES 50 TO 80 WHO HAVE HAD GREATER THAN 25 PACK YEARS OF SMOKING, ONE PART PER YEAR.

IF YOU SMOKED HALF A PACK FOR 50 YEARS THAT IS THE EQUIVALENT OF 25 PACK YEARS AND HAVE NOT QUIT WITHIN THE LAST 15 YEARS.

DR. ELMER: THEY HAVE ENDORSED THE RECOMMENDATION BUT IT WILL HAVE TO BE APPROVED BY THE INSURANCE COMPANIES AND MEDICARE BECAUSE YOU CAN RECOMMEND ONE CANCER SURVEILLANCE CAT SCANS BUT SOMEONE IS GOING TO HAVE TO PAY FOR IT.

RIGHT NOW, THE EXISTING STANDARDS ARE ANYBODY WHO HAS AT LEAST A 30 PACK HERE SMOKING HISTORY -- YEAR SMOKING HISTORY BETWEEN THE AGES OF -- WHO ARE STILL SMOKING OR QUIT WITHIN THE LAST 15 YEARS.

THERE WILL BE A LOT MORE PEOPLE GETTING SCREENED.

DR. WALL: THEY HAVE BROADENED DEAD BUT NOT THE LID ADOPTED IT.

DR. ELMER: THEY WILL HAVE TO HIRE MORE RADIOLOGISTS AND PULMONOLOGIST LOOK AT SCANS.

DR. WALL: A LOW-DOSE LUNG CANCER SCREENING IS A LOW-DOSE CT SCAN, YOU ARE ENES KANTER, IT TAKES MINUTES AND THEN IT IS READ BY A RADIOLOGIST.

DR. CHRISTENSEN: SWITCHING BACK UP TO ASTHMA, HOW DO YOU TREAT THRUSH ON THE TONGUE?

DR. WALL: THERE ARE A COUPLE OF MAINSTAY ANTIFUNGAL DRUGS WE USE AND THE ONE THAT IS NICE IS THE WORKHORSE WE USE, IT COMES IN A LIQUID FORM, AND COUGH DROP LOZENGE FORM, CLASSICALLY THE EASIEST WAY TO TAKE THESE SORT OF LOZENGE COUGH DROP ANTIFUNGAL TABS, YOU TAKE THEM MULTIPLE TIMES PER DAY.

IT DEPENDS ON IF IT IS RECURRING OR NOT BUT USUALLY IT IS TAKEN CARE OF WITHIN A WEEK.

DR. CHRISTENSEN: CANON INHALER CAUSE YOU TO LOSE YOUR VOICE -- CAN AND INHALER CAUSE YOU TO LOSE YOUR VOICE?

DR. WALL: IT IS COMMON AND A LOT OF IT CAN CAUSE CHANGES TO THE VOCAL CORDS AND VOICE CHANGES.

I AM NOT CERTAIN ABOUT WHAT THEY CAN DO TO PRE-EXISTING POLYPS OR IF IT IS MORE OF -- DR. ELMER MAYBE HAS MORE EXPERIENCE.

DR. ELMER: ANY INHALED MEDICATION CAN CAUSE DYSPHONIA WHICH IS VOCAL CHANGES.

IT IS A SIDE EFFECT BUT FOR MOST PEOPLE IT IS NOT AN OVERRIDING ISSUE.

I HAVE HAD A HANDFUL OF PATIENTS, PEOPLE THAT HAVE TO PROTECT -- PROJECTOR BOYS FOR A LIVING WITH THE UNIVERSITY PROFESSOR OR AN ATTORNEY WHO ARGUES CASES IN COURT, A COUPLE HAD TO INTERRUPT THEIR TREATMENT BECAUSE THEY JUST LOST THEIR ABILITY TO PROJECT THEIR VOICE.

BUT LOOKING BACK TO THE THRUSH, THE BEST TREATMENT IS TO PREVENT IT IN THE FIRST PLACE AND THAT'S WHY MAKING SURE YOU RINSE YOUR MOUTH OUT AFTER YOU USE YOUR INHALER.

DR. WALL: I WOULD SAY THE EXACT SAME THING, THE BIG REASON PEOPLE DON'T CONTINUE TO USE AND INHALERS THEY GET IRRITATION.

THEY GET THAT BECAUSE YOU NEED TO RINSE AFTER YOU USE IT.

DR. CHRISTENSEN: SOMETHING I WANT TO HEAR YOU TALK ABOUT BRIEFLY, SMOKING TOBACCO AND COVID VACCINATIONS.

YOU HAVE ABOUT A MINUTE AND A HALF.

DR. ELMER: IN ADDITION TO BEING A PULMONOLOGIST ENDOCRINE ASH I'M A CRITICAL CARE DOCTOR AND I'VE BEEN WORKING WITH COVID PATIENTS FOR THE LAST YEAR, I TAKE EVERYONE TO TAKE ADVANTAGE OF THE MIRACLE OF VACCINES TO REDUCE YOUR CHANCES.

LAST WEEK I WAS TAKING CARE OF PATIENTS, TWO ON LIFE SUPPORT, THEY WERE ALL YOUNGER THAN ME AND NONE HAD BEEN VACCINATED.

GET YOUR CODE VACCINE AND YOU COULD SAVE YOUR LIFE OR THE LIFE OF SOMEBODY YOU LOVE.

DR. WALL: IT IS REALLY TOUGH TO ARGUE WITH THE NEAR 100% EFFICACY OF THESE VACCINES PREVENTING DEATH FROM SEVERE COVID.

SO ABSOLUTELY.

AS MANY, AS I BELIEVE THE GOVERNOR SAID, THE VACCINE IS OUR WAY OUT OF THIS CRISIS.

AND IT IS REMARKABLY EFFECTIVE AT PREVENTING DEATH.

DR. CHRISTENSEN: AND WITH THAT WE SHOULD ALSO SAY SMOKING TOBACCO IN ANY FORM IS A NO-NO.

WE WANT TO THINK OUR PANELISTS, DR. WAYNE ELMER AND DR. JASON WALL.

PLEASE JOIN HOST DR. MARY OWEN NEXT WEEK FOR A PROGRAM ON "HEART ATTACKS, HEART FAILURE, ANEMIAS AND BLEEDING PROBLEMS" WHEN HER PANELISTS WILL BE DR. MARK ERHARD AND DR. VICTORIA HEREN.

THANK YOU FOR WATCHING AND HAVE A GREAT EVENING.

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