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- Hi, I'm Susan Taylor
with Scripps Health in San Diego, California.
Are you short of breath?
Do you have a chronic cough?
You might have a disease of the lung called COPD,
Chronic Obstructive Pulmonary Disease.
Joining us to talk about this is Dr. Samir Makani.
He is a lung doctor.
He's the Director of Interventional Pulmonology
and Bronchoscopy at Scripps Memorial Hospital
in Encinitas, California.
Doctor, thanks so much for being with us.
- Thank you, Susan.
Thanks for having me.
- So what is COPD?
Because there's a lot of reasons
why somebody would be short of breath
or somebody would have a cough.
- The COPD stands
for chronic obstructive pulmonary disease.
It's a chronic condition.
It can be related to smoking-related lung injury
to the lung tissue itself here.
Chronic infections can also cause a problem
in the lung tissue as well.
And then lastly, things like asthma,
which become chronic can cause the air passages here
to get tight and not reverse in terms of its damage also.
- And so how common is COPD?
- COPD is fairly common.
It happens in 20 to 30% of individuals
who have an underlying lung disease.
- And how is it different from asthma?
- So when we look at asthma, these air passages in asthma
get tightened up during an attack.
In asthma after you've been treated or with rest,
they will relax.
In COPD, the problem itself
within the lung tissue here is chronic and persistent.
- And what are the symptoms?
- The main symptom is shortness of breath.
Other symptoms can also include chronic cough
and the shortness of breath can also be at rest
or with exertion when you're doing activities.
- So when you're short of breath
is it when you're taking a breath in
or is it when you are letting it out?
- The main problem with emphysema
or COPD related lung injury related to smoking
is when we're trying to take a breath out.
What happens in COPD related to smoking
is the lungs themselves get hyper expanded or stretched out.
And what that causes is the breathing muscle
or the diaphragm to be pushed down,
which doesn't allow people to take a full breath in
or exhale a full breath out.
The lungs also have something called elastic recoil,
where the lungs wanna shrink down
and then open up When we're breathing.
When we have a problem of emphysema-related lung injury
related to smoking,
we lose that rubber band, nice new rubber band
where the lung can move open and closed freely.
It opens and then does not decrease completely as it should.
- What's the difference between COPD and emphysema?
- The COPD, chronic obstructive pulmonary disease,
is a diagnosis made by breathing tests.
So you come to your lung doctor's office,
they'll do breathing tests, and then we use those numbers
to define whether you have COPD
or other lung related abnormalities.
When we talk about emphysema,
emphysema is more of a problem we see with your anatomy
or something we diagnose on a CT scan
or chest x-ray or something like that.
So, COPD itself is the functional problem of the lung.
Emphysema is what we see in terms of structure
or damage of the lung itself on a picture.
- And who's most at risk for COPD?
- The primary cause in the United States
still remains smoking.
Other causes do include things like chronic infection
as well, and then asthma also falls in that category also.
- And what percentage of smokers have COPD?
- About 20 to 30% of smokers
do have underlying COPD or emphysema.
- And when do people most often
start exhibiting symptoms of COPD?
- The symptoms can usually come in your fifties or later.
It is variable.
Some individuals will present sooner and some later,
but generally around that time.
- And does it get worse over time?
- It can.
So, if the insult continues,
so if patients continue to smoke cigarettes or vape
or other exposures such as diesel fuels
or other things like that continue,
the COPD will get worse over a period of time.
- And this can limit what activities?
- It can limit things like exertions.
So if you wanted to go hiking
or do some type of sporting event,
that may limit in extreme situations.
It can also limit, we call your activities of daily living.
It can be difficult to even take shower, go get the mail,
or simple tasks that you would do on a day to day basis.
- How do you diagnose somebody with COPD?
- So, if you have complaints of shortness of breath
and you present to your primary care doctor,
they'll refer you on to a lung specialist.
The first test we'll do is breathing tests.
The breathing tests will define
how your lungs are functioning
in terms of how much air you take in
and how you take the air out
and how much oxygen your body is absorbing as well.
- And how do you treat COPD?
- There's multiple ways.
One, we use inhalers which will stretch out the lungs
and make oxygen and your airflow in your lungs better.
The other options include oxygen.
We do something called pulmonary rehabilitation
where it's essentially an exercise program for your lungs.
And then there's more advanced therapies.
One of those is something called lung volume reduction
that's done in two different ways.
And then lastly, lung transplant is also an option as well.
- But there is some incredible technology now
to treat severe COPD.
What is the Zephyr Valve?
- That is correct.
So conceptually we wanted to follow the same concept
of decreasing the overall lung size
to decrease this problem called hyperinflation.
So, over the last 15 years we've been working
on methods to do that in a minimally invasive fashion.
So these valves called endobronchial valves,
which you can see here,
are placed in the lung in a minimally invasive fashion
through the mouth such that we can decrease
some of the lung volume from the inside.
Conceptually it's the same
where we decrease the overall size of the lung,
which puts everything kind of back in the position
it should be so patients can breathe better.
- [Susan] And this is a minimally invasive procedure?
- [Dr. Makani] Yes, correct.
So it's a minimally invasive procedure
performed bronchoscopically with an endoscope
that goes through the mouth down into the lungs
and then we deploy these Zephyr valves
in the area of interest to decrease the size of the lung.
- [Susan] And what is the recovery time?
- [Dr. Makani] After the procedure's done,
we do have to stay in the hospital for three days
to watch for complications,
and then usually about a week and a half at home
patients start to realize the improvement.
Usually at the one month mark
when patients come see me for follow up
is when they really experience the difference.
- And they can get back to doing what they wanna do.
Maybe jogging or playing tennis.
- That's our goal.
So, the things that they were limited to from before
and it can be simple things such as making their bed,
going to get the mail, taking a shower,
going to walk their dog.
These are all the things that I ask
in the preoperative phase,
or what are the things that you're having challenges with
and we wanna make that part of their life better.
- If you are a smoker or a vaper,
and you stop smoking and vaping, can you correct COPD?
- We all have some degree of lung decline
as part of an aging process.
If you quit smoking or have quit vaping,
it usually takes five to 10 years for that to recover
back to what a normal person's lung decline would be.
- When should you go see a lung doctor
to get checked out for this?
- If you had chronic lung infections
or have smoked for a significant period of time,
you should talk to your primary care doctor
especially if you're having symptoms
of shortness of breath at rest or exertion
or you're noticing that the things you'd like to do before
that you're having difficulties doing them
when it comes to physical activity.
It's a great time to talk to your doctor about COPD.
- Any final thoughts, doctor?
- The best way to prevent these problems is to not smoke
or to quit smoking.
If you do have problems with shortness of breath,
there is help out there.
You need to get evaluated.
The best place to start is with your primary care physician.
She or he will refer you on to a lung specialist.
We'll start with lung volumes and other breathing tests
and then we'll go from there to help you out.
- Doctor, thanks so much for being with us.
We appreciate you taking the time.
- Thank you very much.
- If you want more information on COPD,
just click on the link or go to scripps.org/videos.
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At Scripps, we're here for good.
I'm Susan Taylor.
Thanks for joining us.
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