good evening and welcome to doctors on call i'm dr mary owen faculty member within the department of family medicine and biobehavioral health at the university of minnesota medical school and also the director of the center of american indian and minority health i'm a family physician for the fond du lac band of lake superior chippewa and tonight i'm your host for our program on lung problems copd and asthma the success of this program is very dependent on you the viewer so please call in your questions or email them to ask wdse.org the telephone numbers can be found at the bottom of your screen our panelists this evening include dr andrew keenan a critical care and pulmonary medicine specialist with essentia health and dr paul stanford who is an internal medicine specialist with saint luke's internal medicine associates our medical students answering the phones tonight are mackenzie dotzler of avon minnesota amanda peterson from tyler minnesota and elizabeth poskey from cotton minnesota and now on to tonight's program on lung problems copd and asthma welcome to the show both of you thank you for being here this evening thank you so normally i mean i would think that you two are busy as all heck dealing with covid and that's all you do but it sounds like you're still able to see people for other things dr keenan uh yeah we the the doors are still open and we're still maintaining our our clinic and our hospital presence for everything else that can uh either happen to affect your health or things to maintain your health and so the access is still there but we certainly are busier than usual for uh for other reasons dr sanford's same same thing yeah no no it's just the consequences of covert expand beyond just covet infections people isolating at home drinking like fish smoking more not taking care of themselves the consequences have been horrible thank you for that so i'm sure we're going to get lots of interesting questions from our audience but until then i have a few that our medical students came up with that they've heard from their relatives if i have copd do i need oxygen dr keenan that's a good question and luckily for many people the answer is no i think there's a number of things to keep in mind for a person who has copd including really working hard on smoking cessation and i think working with your primary care team or pulmonary team for developing an inhaler regimen that you can maintain also staying up to date on your vaccinations including cold vaccine of course and maintaining physical conditioning and and also i think avoiding people who are have infections or other upper respiratory symptoms a small subset of people with copd will require oxygen and that is usually dependent on what your oxygen saturation or if they put the little sensor on your finger and if that's below a certain level at rest or in some cases if it's low when you're walking or when you're sleeping you may need to have oxygen i do have to have ask a covent question so you're covered patients who are fully vaccinated are they still at higher risk for with your patients with copd and they're fully vaccinated they still at higher risk of getting sick very sick yeah i think that um what uh what we have found is i see predominantly the intensive care unit population in the hospital i think people who are vaccinated including a booster it has really modified their risk for severe disease i think people with severe copd or other severe lung diseases are at increased risk for complications just because they have less reserve um on on the other hand uh people with asthma actually we haven't seen a risk of of complications related to covid so so interesting so copd patients still have to be even more careful even when they're fully vaccinated but we haven't seen as much problems with asthma okay good all of them should still be fully vaccinated and boosted up though thumbs up thanks all right this is an interesting one dr sanford how does acid reflux affect my asthma or copd oh yeah well acid reflux is where especially when you're reclining your stomach contents can come up your food pipe and then percolate in the back of your throat and sometimes irritate the air pipe and the result can be irritation inflammation cough reflex that can extend far into the next day not just at night so good trick is if you have reflux try to avoid eating or drinking anything including water after supper elevate the head of your bed by about you know eight inches of phone books and you know just avoid caffeine and chocolate because those can kind of make the food pipe relax too much and cause more acid reflux do you still have phone books i was gonna have that oh well i'm old-fashioned what can i say dr keenan i was told that my allergies are making my asthma worse how is that uh well asthma and and certain types of allergies travel together because they're impacted by the same aspects of your immune system so this isn't kind of food allergies or gluten sensitivity or that kind of thing these are more the environmental allergies or pets and things like that that can give you the itchy eyes runny nose and that kind of thing much like like reflux that dr sanford was talking about allergies are or related allergic rhinitis and similar processes can impact our ability to control asthma and so even if you're on a solid inhaler regimen if your allergies remain under on uncontrolled it can impact your asthma control speaking of immune i've heard that asthma is related to other immune type conditions is that true it's uh it's not it's not in the same class as say other autoimmune issues like child onset or early onset diabetes or lupus or rheumatoid arthritis but it is related to upper regula probably for many people upregulated parts of the immune system that impact eczema or other kind of less common less common lung diseases thank you for that anything to add dr sanford yeah no anything that irritates the air pipe you know is going to be making people with asthma or other reactive airway disease feel worse dr sanford what should i do if i am having an asthma attack or i see a relative having an asthma attack well you say where the heck is your albuterol inhaler your rescue inhaler and use it and one problem a lot of people have is they don't use it correctly and so if you're new to an inhaler practice it in front of the mirror to make sure that that puff of medicine doesn't just go out and into the air but it goes into your lungs if after a couple puffs you know people are still really working to breathe don't be shy about calling for help 9-1-1 is our friend anything to add dr kian uh no i i agree and um asthma is one of those diseases that's so common that it sometimes it doesn't scare people as much as it should and i think most people have great control and have a good sense of their symptoms but it is something that can start to get out of control quickly and so if somebody if if you aren't feeling better after the measures that dr sanford described it's time to get help i've been surprised uh the number of my patients that don't understand that sometimes asthma if not controlled or not paid attention to can actually even cause death yeah it's happened to more than one of my patients and uh we're starting to see more and more asthma so it's something to really pay attention to thank you both dr keenan how can covet 19 affect my asthma and or cp copd talk a little bit about it but anything else to add yeah i think that both of these are chronic diseases that can impact your daily life and we know that in the in the acute phase when you're first sick with covid as we mentioned people with copd can have somewhat higher risk for having complications from their acute illness but what i've seen and i'm sure dr sanford and his colleagues have seen are more harder to more difficult to describe long-term symptoms of covid with fatigue feeling tired and some kind of mental fogginess and things like that and we know that changes like that can impact our ability to control other chronic diseases and so i think that you've got the short-term effects of the acute infection and then the more long-term difficult-to-measure measure effects of potentially kind of the long covet syndrome thank you anything to add dr sanford oh you're absolutely right i had covert a year ago and to this day by 5 pm i'm just struggling to stay awake so you can imagine it would infect things like people's memory or remembering to take their medications all the other aspects of their life absolutely right thank you if my dad has copd we'll ask you dr sanford if my dad has copd will i get it too no not necessarily there are some types of obstructive airway disease that we don't you know lifestyle habits don't make a difference people with cystic fibrosis which isn't actually an obstructive process or people with uh you know other types of airway problems but if people smoke and you have a family history of tibet of copd or emphysema yeah you're just inviting misery by smoking if it weren't for cigarettes i'd be selling studebakers and phone books and phone books yes and cheeseburgers [Laughter] but yeah i mean if we could avoid tobacco what would the impact be on your world uh it would it would be we would have a lot more clinic availability i think it would and i think we're thinking in the framework of lung problems and so especially copd and lung cancer risk would be far less risk but also risk factor for other types of cancer risk factors for cardiovascular disease and and also i think you'd have a lot of savings for you know other things rather than increasing the expense of cigarettes yeah a lot more time to do other things amen if i quit smoking speaking of which if i do quit smoking 20 years if i quit it 20 years ago can i still get copd so i think after late 20s everybody gradually loses lung function and people who are using tobacco lose lung function at a faster rate once you've quit smoking your rate of loss kind of evens back out to your non-smoking peers and so i think that you if you had a smoking for a significant period of time you will always have probably a slightly higher risk for developing copd but the fact that we're talking about a difference in a time of 20 years ago i think the risk is probably low and and you've accrued all those other benefits from not smoking we know that in general asthma rates are going up or rates of people who have incidents of asthma is going up how about copd that's a good question i think that um we're seeing the the late uh kind of the late end of the effective of smoking becoming more common in women and so i think we'll probably continue to see copd incidents increase in in uh develo in the developing world it's skyrocketing as people as um access to uh cigarettes becomes more widespread and so globally it's marching right on i think in in the united states it's still getting a little more common that's a funny way to put it access to cigarettes in other countries thank you for anyway dr sanford what do i do if i think my copd is getting worse well and you got to talk with your doc about what we can do to try to regulate it you know i mentioned the albuterol but there are lots of other wonderful tools long-acting beta agonists with a long-acting corticosteroid or disease modifying agent i mean that just the spectrum is unbelievable there's so many good options for trying to maintain good airway health anything to add dr king um i think just to dovetail with that i'll i'll sometimes be seeing somebody for an annual visit which i'm sure you uh encounter a lot and they've people have been feeling poorly for six or eight months but they were just waiting for their follow-up visit to discuss it and so i think if you're if you're feeling that your lung disease isn't under good control or your breathing's changing it's important to talk touch base with your team and and figure things out it can be my focus is on lung problems but certainly many things can impact your breathing will run into heart valve problems or cardiovascular disease that we pick up through kind of seeing them from a pulmonary perspective yeah absolutely do you find any of your regular patients for copd or asthma are not visi we've heard about patients being afraid to go in to see their primary do you find that any of the diseases worsened without you having or people are in worse control than you would have expected because being afraid to come in i think especially early on um our population tends to be highly vaccinated i think they're have chronic lung problems and it's on their mind a lot and so we've been seeing more people coming back from clinic a lot of different health care systems have been pushing forward with virtual visits which i think help with access and i there are many people that i have seen for the last year and a half just with virtual visits and so it's helped but there still is that avoidance uh in in some folks it was strange for us as physicians to get used to the virtual wasn't it not being able to listen to the lungs to hear the wheezing yeah to check on the status of our patients yeah i don't like it and i'm old-fashioned i want to be face-to-face with somebody literally touch them check pressures listen to the lungs check the lymph nodes all of that face-to-face yeah the benefit is as you said it increases the access but there is that angst that we all have not being able to actually eyeball our patients so to speak and i think that patients prefer the in-person interaction as well yeah there's something about that that touch as well i think that doctors can offer it's the covenant of medicine you know so much of what we do isn't necessarily just the technical part but like with some of my patients i've known for 30 years i get invited to weddings funerals i get cookies mmm i don't get any cookies cheeseburgers yeah oh cheeseburgers too yeah but i mean that's such an important part of what we do it's the empathy it's the relationship right conveying love yes loved ones absolutely absolutely even in critical care hey yeah yeah usually it's for the people who are caring for in their families that's right that's right how do i know if my kid has asthma that's a good question uh and i moved out of the pediatric realm a while ago but oh sorry about that no no that's fine the i think wheezing in children is very common and i think that many kids can have episodic wheezing after upper respiratory infection and i think that if you notice that you have a pattern of wheezing that is becoming more frequent or it's not improving when the other symptoms improve or certainly anything that's prompting visits to the er the hospital it's time to talk to your family doc about about our pediatrician about possibility of asthma thanks for that dr sanford anything to ask because i add because i know oh no internal medicine yeah i don't take care of kids my youngest patients 90. but still you know anybody was having you know since he was 60. yeah but anybody who's having persistent problems with breathing whistling as they exhale having a more difficult time breathing air out than breathing air in obstructive airway disease means that you're trapping air in your lungs and it's harder to get it out where other problems where you have more trouble breathing in may be related to the upper airway above the chest cavity so anytime you have a change in your breathing you know you want to know for kids the changes in activity what they're able to do compared to their peers yeah are not able to do right right all right if you are i'll ask you dr sanford if you're diagnosed with mild emphysema is there a chance to heal it on its own it'll heal on its own you can prevent it from getting worse but you can't peel the damage that's been done when we're you know 18 years old and we have never smoked you know we have millions of little air sacs that build that make the lung once i heard one teacher say that if you were to cut them each open and lay them flat it would cover two tennis courts i don't know if that's true or not it's always a sport analogy yeah football fields but you know surf surface area but when you smoke cigarettes you destroy the walls between all those millions of little air sacs so instead of millions of little efficient air sacs you get maybe a couple hundred big grape sized air sacs that are floppy and they collapse on themselves and trap air and you just can't breathe out um so again the message if you don't smoke hallelujah if you do smoke quit but once you have emphysema you have it for the rest of your life yeah bronchiectasis what causes it is there a cure if so what is it that's a good question so bronchiectasis is a it's a disease of the larger airways and it's over a period of time due to recurrent episodes of inflammation they become dilated and abnormal and so that inflammation can be from airway injury infection or underlying problem with with the airway itself and as the airway dilates and becomes abnormal it doesn't do its job as well which is to conduct air and also to clear mucus out and so i think that that's kind of the the cause as far as treatments for bronchiectasis obviously it comes down to what the addressing the underlying cause you mentioned cystic fibrosis there's some interesting new medications that can actually help modify the uh modify the gene itself and help say if it's due to an abnormal protein it helps the protein fold and improves function and it's been a life-changing intervention for people with cystic fibrosis i think also you can prevent recurrent infections the cornerstone of treatment is using things like either exercise or different types of therapies to help clear the airways often with an inhaled medication along with it there's no there's kind of like emphysema once the damage is there with airways the main goal is to prevent worsening of damage the only treatment for reversal of bronchiectasis would be the most radical which for cystic fibrosis would be lung transplant and that's what all that other stuff is is built to either delay or prevent the need for that but for the vast majority of cases of bronchitis it's not that severe thank you dr sanford how does how does severe sleep apnea affect lungs or risk for c c covin well obstructive sleep apnea as you may know is where when you relaxed and you're in deep sleep your airway doesn't stay open and the result is that you have to partially wake up in order to open up your airway and breathe some more and so instead of being in a nice steady level of sleep and then waking up your sleep is just like a sawtooth and the result can be not only exhaustion the next day but also increased blood pressure in the lungs higher risk of something called atrial fibrillation which is where the upper heart chamber just wiggles instead of beats regularly it doesn't probably have any impact on risk for covid that i've ever heard of but the snoring alone sometimes is bad enough that they have to move an airport because they can't hear the planes maybe comorbidities because people who get sleep apnea tend to be people who are a little heavier and which makes you a higher risk for absolutely um bad covered infections does marijuana help protect against covid no would you like to extrapolate no no no yeah there's no no that's a simple one yep thank you asthma is it normal to cough up green mucus with an asthma diagnosis i think when they've done studies on the color mucus for any reason uh it doesn't seem to actually correlate we sometimes ask about darker mucous or different colors so as long as long as it's not bloody the color of the mucus doesn't tend to matter much and i think for asthma a cough that can be at times productive is pretty common i think if what i tell people with asthma or copd is they've got their usual spectrum of symptoms and for some people coughing up a lot of mucus every morning might be normal but i think if they have a change in their daily symptoms especially one that persists for a few days that's what should preclude you know is has there been a change in my health okay okay good can exposure to burn pits lead to lung disease wow that one well our afghan and um you know iraq war veterans you know burn pits have led to a lot of different weird stuff you know especially the neurotoxins and i've seen some just horrible type of neurodegenerative diseases that we assume is from the burn pits because we can't find anything else that would cause it as far as obstructive airway disease or pulmonary disease i haven't heard yeah it's an area of ongoing interest and the va has a registry for burn pit related illnesses when they they've done studies in people with symptoms but normal uh breathing tests and normal imaging and on lung biopsy they could see some changes but whether i think a lot of these people have been working in so many different settings kind of isoli i think a lot of that the public health part of that isolating the exposure is really difficult so i think that in people with intense exposure it impacts their lungs in in some way but it's in a way that we can't measure i have taken care of some people who i think had already had asthma that was exacerbated by that exposure but yeah area of ongoing research and probably put them at higher risk for scarring or whatever else happened yeah and that's where we don't know really the type of chemical which could vary varies incredibly widely okay is there a role for stem cell treatments in treating or curing copd and i'll leave that open to either of you i've not heard so i thought i might run into this question so i checked it out today and there's i think if you get if if you read about any place offering stem cell treatment right now they're just looking for they're just going to accept your cash and there won't be any benefit it is an area of of study but these are very very early basic science level studies the there's nothing's ready for the clinical world it's very very preliminary and it's exciting but i think we always are looking for hope and so i get that question actually surprisingly often and so nothing nothing is live right now so good questions but we don't have the answers quite yet a little too good is a diagnostic long ct needed if a previous scan showed nodules in the lobe of my lungs well yeah diagnostic if you're a person with at least 10 year history of tobacco you want to get some type of a low radiation dose ct on a regular basis if they've already found a mass then doing a high resolution ct with contrast is important to see if it's growing changing is it possibly cancerous or is it an old scar what are your feelings yeah we these scans are so detailed that we find any number of spots large medium and small and so i think that's where following up with uh with your doctor to get a plan set up and a follow-up is critical in that setting well thank you both this has been great um anything last second that you want to add we have about 15 seconds i think oh please get your covered vaccine amen and stop smoking stop smoking cheeseburger i'll take the covered vaccine i like cheeseburgers [Laughter] i want to thank our panelists dr andrew keenan and dr paul sanford and our medical student volunteers mackenzie dotzler amanda peterson and elizabeth potsky please join dr peter naylan next week for a program on ear nose and throat problems including sleep sleep apnea when his panelists will be dr andrew davis and dr dave hutchinson thank you for watching and good night [Music] you