What You Should Know About COPD (Recording)

 

This webinar was recorded on February 9th 2023.

Did you know that COPD is the 6th leading cause of death in the U.S.? Join us for a presentation from Learn More Breathe Better®, a program of the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health. NHLBI’s Dr. Mihaela Stefan will present key facts and the latest research on COPD.

Speaker:

• Dr. Mihaela Stefan

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Transcript:This transcript is automatically generated. While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

Andrea: HELLO, THANK YOU FOR JOINING US TODAY. WE HAVE A FEW HOUSEKEEPING ITEMS BEFORE WE START THE PROGRAM. I’M ANDREA JENSEN OF THE ALLERGY ASTHMA NETWORK. WE WILL BE RECORDING TODAY’S WEBINAR AND IT WILL BE POSTED ON OUR WEBSITE WITHIN A FEW DAYS. SO YOU CAN LISTEN TO IT AGAIN OR FEEL FREE TO SHARE IT IS ONE OF YOUR COLLEAGUES. YOU CAN GO TO OUR WEBSITE, WWW.ALLERGYASTHMANETWORK.ORG AND SCROLL TO THE BOTTOM OF THE PAGE. YOU WILL FIND OUR RECORDED WEBINARS AND ANY UPCOMING WEBINARS. THE WEBINAR WILL BE ONE HOUR AND THAT INCLUDES TIME FOR QUESTIONS. WE WILL TAKE THE QUESTIONS AT THE END BUT YOU CAN PUT THEM IN THE Q&A AT ANY TIME. WE HAVE SOMEONE MONITORING THE CHAT. IF YOU HAVE QUESTIONS OR NEED HELP, SHE IS THERE TO HELP YOU. WE WILL GET TO AS MANY QUESTIONS AS WE CAN BEFORE WE CONCLUDE. WE DO NOT OFFER CEU FOR THIS PARTICULAR WEBINAR BUT WE DO HAVE CERTIFICATES OF ATTENDANCE. YOU MAY HAVE NOTICED WE ARE USING A DIFFERENT PLATFORM THIS YEAR SO INSTEAD OF BEING ABLE TO DOWNLOAD THE CERTIFICATE DURING THE WEBINAR YOU WILL RECEIVE AN EMAIL WITHIN A FEW DAYS WITH THE RESOURCES ABOUT COPD AND THE PROGRAMS WE ARE TALKING ABOUT TODAY AS WELL AS A LINK TO DOWNLOAD YOUR CERTIFICATE. WE WILL NOW BEGIN TODAY’S WEBINAR. DID YOU KNOW THAT COPD IS THE SIXTH LEADING CAUSE OF DEATH IN THE U.S.? TODAY’S WEBINAR WILL DISCUSS LEARN MORE BREATHE BETTER, A PROGRAM FROM THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE, NHLBI OF THE NATIONAL INSTITUTES OF HEALTH. DR. ANDREA JENSEN WILL PRESENT KEY FACTS ON COPD. IT IS MY HONOR TO PRESENT HER. DR. ANDREA JENSEN IS A — DR. WHAT YOU SHOULD KNOW ABOUT COPD — DR. MIHAELA WAS THE CLINICIAN INVESTIGATOR ASSOCIATE PROFESSOR OF MEDICINE AT THE UNIVERSITY OF MASSACHUSETTS MEDICAL SCHOOL BAYSTATE AND THE ASSOCIATE DIRECTOR OF IMPLEMENTATION SCIENCE AT YOU MMS — UMMS BAYSTATE DELIVERY FOR POPULATION SCIENCE. THANK YOU FOR BEING WITH US TODAY, DR. STEFAN, FOR YOUR UNIQUE PERSPECTIVE ON TREATING THOSE WITH RESPIRATORY INFECTIONS.

DR. STEFAN: ALL RIGHT. HELLO, EVERYONE. I’M VERY SORRY BUT MY CAMERA IS NOT WORKING. THE TECHNOLOGY ALWAYS GIVES US SOME CHALLENGES. SO YOU WILL SEE ONLY MY PICTURE. THANK YOU FOR PARTICIPATING TODAY. I HOPE THAT THIS PRESENTATION WILL BE INFORMATIVE AND I AM LOOKING FORWARD TO ANSWERING SOME OF YOUR QUESTIONS. SO WE WILL START WITH SOME FACTS. COPD STANDS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE. MEANING THAT THERE IS CHRONIC INFORMATION OBSTRUCTING AIRFLOW FROM THE LUNGS. DEPENDING ON THE YEAR AND THE STATISTICS, COPD IS THE FOURTH OR SIXTH LEADING CAUSE OF DEATH IN OUR CUT IT IS RESPONSIBLE FOR 100 AND 50,000 DEATHS PER YEAR. MORE THAN 60 MILLION PEOPLE HAVE BEEN DIAGNOSED WITH COPD. BUT UNFORTUNATELY THERE ARE MANY MORE WHO HAVE THE DISEASE BUT DO NOT KNOW IT. COPD AFFECTS ONE IN EIGHT AMERICANS AGE 45 AND OLDER AND SOMETHING THAT THEY WILL SAY SEVERAL TIMES DURING THE PRESENTATION IS THAT ALTHOUGH THERE IS NO CURE YET FOR COPD, IT CAN BE PREVENTED AND IT CAN BE TREATED. SO, BEFORE DEFINING COPD I WANT TO BRIEFLY EXPLAIN THE PHYSIOLOGY OF THE NORMAL LUNGS. AIR COMES IN THROUGH YOUR NOSE AND MOUTH. MOVES THROUGH THE BIG PIPE, THE TRACHEA, DOWN INTO THE LUNGS. AIR MOVES FARTHER INTO YOUR LUNGS THROUGH THE PAROCHIAL TUBES AND IT ENDS UP IN SOME AIR SACS AT THE END OF THESE AIRWAYS. THE SACS ARE CALLED LBO LIE. — LALVIOLI. OXYGEN IS ABSORBED INTO THE BLOOD AND CARRIED INTO THE BLOOD TO ALL PARTS OF YOUR BODY TO HELP THE BODY FUNCTION. CARBON DIOXIDE THAT IS A TOXIN IS RELEASED FROM YOUR BLOOD AND BREATHED OUT. COPD REFERS TO A GROUP OF DISEASES THAT CAUSE AIRFLOW BLOCKAGE. OK, THE OTHER WAY. IT INCLUDES TWO MAIN CONDITIONS. CHRONIC BRONCHITIS AND EMPHYSEMA. CHRONIC BRONCHITIS OCCURS WHEN THE BRONCHIAL TUBES ARE IRRITATED AND SWOLLEN AND THEY PRODUCE EXCESS MUCUS. YOU CAN SEE IN THIS GRAPH THAT THE NORMAL TUBE HAS A LARGER DIAMETER THAN YOU WANT — DIAMETER, WHICH YOU WANT. THIS CAN CAUSE SHORTENING OF BREATH. ALIGNING THE BRONCHIAL TUBES OF THE LUNGS ARE FIBERS CALLED CILIA THAT HELP TO MOVE THE MUCUS UP THE BRONCHIAL TUBES SO IT CAN BE COUGHED OUT. IN CHRONIC BRONCHITIS, THE TUBES LOSE THEIR CILIA, MAKING IT HARD TO COUGH UP MUCUS OUT OF THE LUNGS. SMOKING, EVEN JUST A LITTLE, KEEPS THE CILIA FROM WORKING NORMALLY. THE OTHER CONDITION IS EMPHYSEMA. THE DAMAGE TO THE AIR SACS CAUSES EMPHYSEMA. THE WALLS INSIDE THE ALVEOLI, THE SACS, DISAPPEAR, MAKING THE MANY SMALL SACKS BECOME LARGER SACS. THE LARGER SACS DO NOT TRANSFER OXYGEN FROM HERE TO THE BLOOD AS WELL. AND WHEN THE ALVEOLI ARE DAMAGED, THE LUNGS BECOME SAGGY AND TRAPPED IN THE LUNGS, WHICH IS WHY THERE IS THIS FEELING THAT YOU CANNOT TAKE A DEEP BREATH IF YOU HAVE COPD. THEY OVERLAP IN PATIENTS. IT’S NOT THAT PATIENTS WOULD HAVE ONLY CHRONIC BRONCHITIS OR EMPHYSEMA, THEY COULD HAVE BOTH. A FEW WORDS ABOUT ASTHMA AND COPD. SOME PEOPLE HAVE ASTHMA AND CAN ALSO DEVELOP COPD. ESPECIALLY IF THEY SMOKE. AND IF THEY ARE OLDER. ADD SOME A IS A CHRONIC LUNG DISEASE THAT INFLAMES AND TIGHTENS THE AIRWAYS. JUST TO REMIND YOU, ASTHMA HAS AIRFLOW OBSTRUCTION AND THE SYMPTOMS VARY WIDELY FROM DAY TO DAY. THEY ARE WORSE AT NIGHT AND IN THE EARLY MORNING. PEOPLE WITH ASTHMA HAVE FREQUENTLY ECZEMA. AND IT OCCURS FREQUENTLY IN CHILDREN. PEOPLE HAVE FAMILY HISTORIES OF IT. ASTHMA TREATMENTS CAN REVERSE THE TREAT — THE NARROWING BUT IN THE PRESENCE OF COPD MUCH OF THIS IS LOST AND WE WILL TALK A LITTLE BIT MORE ABOUT WHAT’S HAPPENING IN COPD. THERE IS SOMETHING CALLED ASTHMA COPD OVERLAP SYNDROME, OR ACOS, WHERE YOU HAVE SYMPTOMS OF ASTHMA AND COPD. IT’S NOT A SEPARATE DISEASE BUT RATHER A WAY FOR DOCTORS TO RECOGNIZE THAT THERE IS A MIX OF SYMPTOMS AND SELECT THE MOST APPROPRIATE TREATMENT PLAN. WE THINK OF ACOS IN A PATIENT WITH PERSISTENT AIRFLOW LIMITATIONS. THE PATIENT IS USUALLY ORDER — OLDER THAN ASTHMA OR WHEN THEY ARE GIVING A — GIVEN A BRONCHODILATOR, THERE’S SOMETHING THAT OCCURS THAT DOESN’T HAPPEN IN COPD. WE KNOW THAT PEOPLE WITH THIS DIAGNOSIS TEND TO HAVE MORE SYMPTOMS THAN PEOPLE WITH EITHER ASTHMA OR COPD ALONE. THE SYNDROME WAS DEFINED NOT A VERY LONG TIME AGO AND WE DON’T UNDERSTAND WELL THE MECHANISM OF THE DISEASE AND AS SUCH, WE DON’T HAVE GOOD TREATMENTS. THIS IS WHY WE NEED MORE RESEARCH TO UNDERSTAND THIS CONDITION. NOW, GOING BACK TO COPD, WE WILL TALK ABOUT THE CAUSES AND RISK FACTORS. IN A NUTSHELL THE MOST IMPORTANT ARE HISTORY OF SMOKING, LONG-TERM EXPOSURE TO LUNG IRRITANTS, AND A RARE DEGENERATIVE CONDITION. SMOKING — COPD DEATHS. 75% OF PATIENTS WITH COPD HAVE A HISTORY OF SMOKING. SMOKERS INHALE MORE THAN 40,000 CHEMICALS AND MORE THAN 40 OF THESE CAUSE CANCER. WHEN SMOKE ENTERS THE LUNGS IT CAUSES YOUR ROTATION AND INFLAMMATION. THE BODY SENDS WHITE BLOOD CELLS TO THE AREAS. THE WHITE MUD CELLS RELEASE STRONG ENZYMES THAT DAMAGE THE LUNG TISSUE. HOWEVER, ONLY ONE IN FIVE SMOKERS WILL GET SIGNIFICANT COPD. RESEARCHERS ARE TRYING TO FIND OUT WHY SOME SMOKERS GET COPD AND OTHERS DON’T. WHAT TEXAS SOME SMOKERS FROM GETTING COPD? I WANT TO ADD TO THAT, ONE OUT OF FOUR PEOPLE WHO HAVE COPD HAVE NEVER SMOKED. IN ADDITION TO THE SMOKER, SMOKING, THERE ARE A FEW OTHER REASONS TO GET COPD. ONE, LONG-TERM EXPOSURE TO LUNG IRRITANTS. CHEMICALS LIKE AMMONIA, SECONDHAND SMOKE, DUST AND FUMES. THERE IS A GENETIC DISEASE MEANING IT’S PASSED FROM PARENTS TO THEIR CHILDREN. THIS IS CALLED ALPHA 1 ANTITRYPSIN OR AATD. THEY HAVE A MUCH LOWER THAN NORMAL LEVEL OF A BLOOD PROTEIN. IT PROTECTS THE LUNGS FROM IRRITATION BY INFECTION OR BREATHING IN TOXIN. YOU CAN FIND OUT IF YOU HAVE ALPHA ONE THROUGH A SIMPLE BLOOD TEST AND IN FACT GUIDELINES RECOMMEND THAT EVERYONE WITH COPD SHOULD BE TESTED FOR ALPHA ONE. THIS IS VERY IMPORTANT BECAUSE THERE IS A SPECIFIC TREATMENT FOR ALPHA ONE DEFICIENCY THAT CAN SLOW THE PROGRESSION OF COPD. WHO IS AT HIGHER RISK FOR COPD? INTERESTING, WOMEN ARE AT HIGHER RISK THAN MEN AND ON THE RIGHT SIDE IN GREEN YOU SEE THAT OF THOSE AFFECTED, THOSE WITH COPD, 56% ARE WOMEN AND 44% ARE MEN. PEOPLE WHO ARE OLDER OR 65. THOSE WITH A LESS THAN HIGH SCHOOL EDUCATION. CURRENT AND FORMER SMOKERS, BUT YOU SEE ALSO ON THE RIGHT. BY SMOKING HISTORY, 38% OF PATIENTS WITH COPD ARE CURRENT SMOKERS AND 37% ARE FORMER SMOKER. PEOPLE WITH HISTORY OF ASTHMA. ALSO, COPD IS MORE FREQUENT IN RURAL AREAS THAN IN URBAN AREAS. BUT IN SOME AREAS IN THE UNITED STATES, SOME AREAS OF THE MISSISSIPPI AND OHIO RIVER VALLEY. WHEN WE THINK BY RACE, 9% OF AMERICAN INDIANS AND ALASKAN NATIVES HAVE COPD. COMPARED WITH 5% OF WHITES, 5% OF NON-HISPANIC LACKS, 2% HISPANIC, 1% IN ASIAN. SO WE SEE THAT THERE IS A DIFFERENCE BY RACE. HOW TO DIAGNOSE COPD IS BASED ON SIGNS AND SYMPTOMS AND WE WILL DISCUSS THIS IN A FOLLOWING SLIDE. PERSONAL MEDICAL HISTORY, WHAT WE JUST DISCUSSED LIKE RISK FACTORS, SMOKING, HISTORY, EXPOSURE TO LUNG IRRITANTS, SECONDHAND SMOKE, CHEMICAL FUMES, AIR POLLUTION AND DUST. A PHYSICAL EXAM. AND TEST SUCH AS CHEST X-RAY, SPIROMETRY, CHESSON T. — CHEST CT. SYMPTOMS CAN BE DIFFERENT FOR EACH PERSON BUT COMMON SYMPTOMS ARE CONSTANT COUGHING, SOMETIMES WE CALL IT SMOKER COUGH. SHORTNESS OF BREATH WHILE DOING EVERYDAY ACTIVITIES. INABILITY TO BREATHE EASILY. SO, TAKING A DEEP BREATH IS DIFFICULT ACCESS OF MUCUS PRODUCTION COSTS — COUGHED UP AS SPUTUM. AND WHEEZING, YOU MAY HEAR FROM SOME WHO HAVE ASTHMA OR COPD A SOUND. THAT’S WHEEZING. IT’S EASY TO THINK OF SHORTNESS OF BREATH AND COUGHING AS A NORMAL PART OF AGING. BUT THIS COULD BE A SIGN OF COPD . MILLIONS OF PEOPLE DO NOT THEORIZE THEY HAVE COPD AND ARE UNDIAGNOSED AND UNTREATED. COPD CAN PROGRESS FOR YEARS WITHOUT NOTICEABLE SHORTNESS OF BREATH. THAT IS WHY IT IS IMPORTANT TO TALK WITH YOUR HEALTH CARE PROVIDER AS SOON AS YOU NOTICE EVEN SMALL SYMPTOMS. AND YOU SEE ON THE RIGHT THAT THE TOP DIAGNOSIS BARRIERS THAT HEALTH CARE PROVIDERS ENCOUNTER, OF COURSE VALID FOR COPD, 44% OF PATIENTS DO NOT REPORT THEIR SYMPTOMS. THEY THINK THAT THIS IS PART OF MY SMOKING. IT IS THE COUGHING THAT IS THE SMOKER COUGH. FOR AGAIN, THAT SHORTNESS OF BREATH IS JUST BECAUSE I GOT OLDER. 35% GO TO THE DOCTOR BUT HAVE MORE IMMEDIATE HEALTH ISSUES AND THEY DON’T BRING IT UP. OR THE PATIENT DOESN’T FULLY REPORT SMOKING HISTORY. COPD IS USUALLY DIAGNOSED THROUGH A LUNG FUNCTION TEST SUCH AS SPIROMETRY. IT’S A QUICK, PAINLESS, SIMPLE BREATH BREATHING TEST THAT CHECKS HOW WELL YOUR LUNGS ARE WORKING. IT MEASURES THE AMOUNT OF AIR OR A PERSON CAN BLOWOUT OF THE LUNGS AND HOW FAST THEY CAN BLOW IT OUT. AFTER THE FIRST MEASUREMENTS ARE TAKEN, BRONCHODILATOR MEDICATION IS GIVEN IN THE PULMONARY FUNCTION TEST THAT — IS MEASURED AGAIN. THIS IS WHAT WE WERE DISCUSSING EARLIER ABOUT THE DIFFERENCE BETWEEN ASTHMA AND COPD. WITH A BRONCHODILATOR, AND AT HIS MOTHER IS A LARGER ABILITY WHILE IN COPD IT IS MINIMAL. YOUR DOCTOR MAY ORDER ADDITIONAL TESTS TO GET A MORE COMPLETE PICTURE OF HOW YOUR LUNGS ARE FUNCTIONING. BUT SPIROMETRY IS EXTREMELY IMPORTANT FOR THE DIAGNOSIS OF COPD. TWO ASSESS HOW SEVERE IT IS. ALSO YOU CAN FIND OUT WHETHER OTHER CONDITIONS SUCH AS ASTHMA OR HEART FAILURE ARE CAUSING THE SYMPTOMS. NOW WE ARE GOING TO MOVE TO TREATMENT OF COPD. I’M GOING TO SAY THAT, AGAIN, THERE IS NO CURE YET FOR IT, BUT TREATMENTS ARE AVAILABLE TO HELP INDIVIDUALS FEEL BETTER WITH THESE CONDITIONS. SO DON’T BE DISCOURAGED IF YOU HAVE COPD. LIFESTYLE CHANGES IN TREATMENTS CAN GREATLY IMPROVE A PATIENT’S QUALITY-OF-LIFE AND ALLOW THEM TO STAY MORE ACTIVE AND SLOW THE PROGRESSION OF THE DISEASE. LIFESTYLE CHANGES ARE HARD. THEY ARE HARDER THAN TAKING PILLS. THE MOST IMPORTANT ARE QUIT SMOKING. WE WILL TALK ABOUT THIS IN THE NEXT SLIDE. AVOIDING POLLEN. HAVING SUFFICIENT VENTILATION, NONPOLLUTING COOKING STOVES ARE RECOMMENDED. ALSO, YOU CAN CHECK THE AIR QUALITY ON A WEATHER APP AND DECIDE IF MAYBE THERE ARE DAYS WHERE IT’S MORE APPROPRIATE TO STAY INDOORS. EXERCISING IS IMPORTANT. WE WILL TALK ABOUT PULMONARY REHAB AND HOW IT CAN HELP YOU BECOME MORE ACTIVE. KEEPING YOUR WEIGHT IN CHECK. VISITING YOUR PROVIDER REGULARLY , TAKING YOUR PRESCRIBED MEDICATION, THAT’S IMPORTANT. STAYING CURRENT WITH YOUR VACCINATIONS. I CANNOT EMPHASIZE MORE HOW SIGNIFICANT FOR THE PATIENT IT IS TO HAVE SUPPORT FROM FAMILY AND FRIENDS. WE’LL TALK ABOUT THIS. WE HAVE A TOOLKIT FOR THE CAREGIVERS AND HOW THEY CAN HELP THEIR LOVED ONES WITH COPD. QUITTING SMOKING. SO IF YOU ARE CURRENTLY A SMOKER , THE MOST IMPORTANT THING YOU CAN DO TO SLOW THE PROGRESSION OF YOUR COPD IS TO QUIT SMOKING. YOU SHOULD TALK WITH YOUR DOCTOR ABOUT PROGRAMS AND PRODUCTS THAT CAN HELP YOU QUIT. WE HAVE A NATIONAL QUIT LINE. YOU CAN CALL IT, ONE 800 QUIT NOW, TO CONNECT DIRECTLY TO YOUR STATE QUICK LINE AND GET ACCESS TO FREE LOCAL RESOURCES. THERE IS ANOTHER GOVERNMENT SITE , SMOKE-FREE.GOV. THERE ARE MANY OPTIONS AVAILABLE TO HELP YOU QUIT SMOKING AND THESE OPTIONS INCLUDE GUM, PATCHES, AND PRESCRIPTION MEDICINE AMONG OTHERS. IF YOU HAVE TROUBLE QUITTING SMOKING ON YOUR OWN, CONSIDER ALSO JOINING A SUPPORT GROUP. BUT ASK YOUR FAMILY MEMBERS AND FRIENDS TO SUPPORT YOU IN YOUR EFFORTS TO QUIT. WHILE YOU ARE UNLIKELY TO RETURN LUNG FUNCTION TO NORMAL AFTER QUITTING FROM — SMOKING, YOU WILL SLOW THE PROGRESSION OF YOUR COPD. IF YOU HAVE ALREADY QUIT SMOKING, CONGRATULATIONS. NOW, WE WILL TALK ABOUT THE TREATMENT OF COPD, WHICH CAN INCLUDE MEDICATIONS, OXYGEN THERAPY, PULMONARY REHAB, SURGERY, LUNG TRANSPLANT, PALLIATIVE CARE. ON SOME OTHER SLIDES WE WILL TALK ABOUT PULMONARY REHAB AND PALLIATIVE CARE. BUT A FEW WORDS ABOUT WHAT MEDICATIONS. THERE’S A VARIETY OF MEDICINES USED TO TREAT COPD AND THERE IS NO BEST MEDICINE FOR OLD PEOPLE. EACH PERSON’S COPD IS DIFFERENT IN YOUR DOCTOR HEALTH CARE TEAM WILL WORK WITH YOU TO SET UP THE BEST PLAN TO ADDRESS YOUR SENTENCING NEEDS. IN REGARDS TO THE MEDICATION, THERE ARE TWO IMPORTANT CLASSES. IF YOU HAVE COPD, YOU ARE WELL AWARE. ONE IS RONCO DILATORS. THEY RELAX THE MUSCLES AROUND THE AIRWAYS AND MAKE BREATHING EASIER. MOST BRONCHODILATORS CAN BE NEBULIZED. INHALERS OPERATE IN DIFFERENT WAYS. MAKE SURE TO ASK YOUR HEALTH CARE TEAM TO SHOW YOU HOW YOUR SPECIFIC INHALER WORKS AND ALSO MAKE SURE YOU ARE DOING IT CORRECT. SO, ASK YOUR CARE TEAM TO SEE THAT THE WAY YOU ARE DOING IT IS CORRECT. THE OTHER CLASSES ARE INFLAMMATORY MEDICATION — ANTI-INFLAMMATORY MEDICATIONS LEADING TO LESS SWELLING IN THE AIRWAY, MAKING IT EASIER TO BREATHE. THESE MEDICATIONS ARE KNOWN AS CORTICOSTEROIDS OR STEROIDS. SOMETIMES WITH COPD YOU REQUIRE EXTRA OR SUPPLEMENTAL OXYGEN. THERE ARE SEVERAL DEVICES USED TO DELIVER OXYGEN. YOUR HEALTH CARE PROVIDER WILL HELP YOU CHOOSE THE EQUIPMENT THAT WORKS BEST FOR YOU. WITH REGARDS TO SURGERY, SURGERY TAKES CARE OF THE EMPHYSEMA COMPONENT OF COPD. SO WHEN THE AIR SACS ARE DESTROYED AND MAYBE THEY ARE TOGETHER IN THE BUILDING OF A LARGER SACK THAT MAY BE ADDRESSED THROUGH SURGERY. BUT SURGERY IS NOT FOR EVERYONE. THE OTHER OPTION IS TRANSPLANTATION FOR SEVERE COPD. LUNG TRANSPLANTS HAVE BEEN SHOWN TO IMPROVE QUALITY OF LIFE. SURGERY AND LUNG TRANSPLANT OPTIONS YOU CAN BRING UP WITH YOUR PULMONOLOGIST TO DISCUSS IF THESE ARE THERAPIES THAT COULD HELP YOU. SO, NOW SOMETHING ABOUT PULMONARY REHAB. IF YOU OR SOMEONE YOU LOVE SUFFERS FROM A CHRONIC LUNG DISEASE LIKE COPD, THERE IS HOPE FOR BUILDING STRENGTH AND BUILDING A FULLER, MORE ACTIVE LIFE. PULMONARY REHABILITATION CAN HELP YOU WITH THIS IT’S A PERSONALIZED TREATMENT PROGRAM THAT TEACHES MANAGEMENT STRATEGIES TO IMPROVE QUALITY OF LIFE. YEARS AGO, BEFORE I BECAME INTERESTED IN THE PULMONARY FOOD — FIELD, I THOUGHT PULMONARY REHAB WAS MAINLY ABOUT EXERCISE TRAINING. BUT THIS IS NOT THE CASE. THIS PROGRAM INCLUDES IN ADDITION TO EXERCISE TRAINING, IT’S TAILORED TOWARDS YOUR NEEDS AND CAPABILITIES. IT INCLUDES BREATHING TECHNIQUES LIKE YOGA AND MINDFULNESS. INSTRUCTION IN FINDING ENERGY-SAVING WAYS TO DO EVERYDAY TASKS. IT CAN HELP TO STOP SMOKING. ALSO, ONE COMPONENT IS PSYCHOLOGICAL COUNSELING FOR EMOTIONAL PROBLEMS BECAUSE AGAIN, COPD IS A SERIOUS ILLNESS AND YOU MIGHT NEED THIS TYPE OF HELP. AND NUTRITIONAL COUNSELING. PULMONARY HELP MAY HELP PEOPLE WITH CHRONIC BREATHING PROBLEMS TO BREATHE BETTER AND STUDIES HAVE SHOWN THAT TWO OUT OF THREE PEOPLE WHO PARTICIPATE IN PULMONARY REHABILITATION REPORT POSITIVE OUTCOMES LIKE REDUCING COPD SYMPTOMS, INCREASING PHYSICAL ACTIVITY, IMPROVING DAILY LIFE FUNCTION AND EMOTIONAL HEALTH. PULMONARY REHAB CLASSES ARE OFFERED IN A GROUP SETTING. YOU GET THE CHANCE TO MEET OTHERS WITH YOUR CONDITION, WHICH PROVIDES AN OPPORTUNITY TO RECEIVE PIERCE SUPPORT. THE SKILLS AND KNOWLEDGE THAT YOU LEARNED IN THE PROGRAM WILL HELP YOU FEEL BETTER AND MANAGE YOUR CHRONIC LUNG DISEASE. EXERCISING YOUR LUNGS AND YOUR MUSCLES HELP YOU TO BE MORE ACTIVE SO THAT YOU CAN DO THE THINGS YOU ENJOY. IT MAY EVEN DECREASE THE NEED FOR HOSPITAL VISITS. THE BAD NEWS IS ONLY VERY FEW PEOPLE WITH COPD PARTICIPATE IN PR. SOME DO NOT KNOW, THEY GET REFERRED BUT THEY DON’T UNDERSTAND OR DIFFERENT MAYBE, THEIR PROVIDERS DO NOT EMPHASIZE ENOUGH HOW IMPORTANT PULMONARY REHAB IS. OTHER BARRIERS TO PULMONARY HEALTH INCLUDE POOR ACCESS TO PR FACILITIES AND CAPACITY CONSTRAINTS AT THOSE FACILITIES. NOW A VARIETY OF NOVEL MODELS OF PR HAVE BEEN TESTED IN A SMALL CLINICAL STUDY. INCLUDING INDIVIDUAL AND GROUP. WITH SUPERVISION AND MONITORING, TELEPHONE-BASED COACHING MODELS, AND EVEN THE LIGHT TOUCH MODEL USING APPS AND WEBSITES. NOW BY NECESSITY, THE UPTAKE OF THIS REMOTELY DELIVERED CLINICAL PRACTICE HAS ACCELERATED OVER THE LAST FEW YEARS. RESULTS FROM SMALL STUDIES SUCH AS OTHER REHABILITATIONS ARE SAFE AND HAVE BEEN PART OF THE CENTER BASED PR. HOWEVER, WE NEED VIGOROUS STUDIES WITH A REQUEST FOR QUALITY ASSURANCE AND QUALITY CONTROL TO MAKE SURE THAT THE MODELS DELIVER THE EXCELLENT OUTCOMES KNOWN. ON THIS SLIDE YOU SEE THAT ONE OF THE STUDIES THAT IS SUPPORTED BY THE NHLBI IS THE LARGE RIGOROUS TRIAL TESTING TELEHEALTH PR TO UNDERSTAND EXACTLY IF IT CONFERS SIMILAR BENEFITS TO CENTER BASED HELP. NEXT THE PALLIATIVE CARE. IT’S CALLED ALSO SUPPORTIVE CARE . IT’S A SPECIALTY IN MEDICINE FOCUSED ON TREATING THE SYMPTOMS AND STRESS THAT ACCOMPANIES SERIOUS ISSUES LIKE COPD. IT’S AVAILABLE TO YOU FROM THE MOMENT YOU ARE DIAGNOSED THROUGH THE ENTIRE COURSE. PALLIATIVE CARE IMPROVES QUALITY OF LIFE BY RELIVING — RELIEVING PHYSICAL AND EMOTIONAL SYMPTOMS AND IMPROVING COMMUNICATION WITH YOUR HEALTH CARE PROVIDERS. PALLIATIVE CARE SPECIALISTS INCLUDE DOCTORS, NURSES, AND SOCIAL WORKERS. THEY WILL MAKE SURE THAT YOUR SPECIFIC EXPECTATIONS ARE MATCHED WITH THE CARE THAT YOU RECEIVE FOR COPD. PALLIATIVE CARE TEAMS CAN HELP YOU AND YOUR FAMILY UNDERSTAND YOUR TREAT OPTIONS AND GOALS, PLAN FOR THE FUTURE, AND GIVE PRACTICAL ADVICE ABOUT TALKING TO LOVED ONES. THEY ALSO HELP DIFFICULT DECISIONS. I WANT TO EMPHASIZE THAT PALLIATIVE CARE AND HOSPICE ARE NOT THE SAME. I KNOW THAT MANY PEOPLE THINK THAT PALLIATIVE CARE IS REALLY END-OF-LIFE AND THAT IS THE CASE. HOSPICE IS FOR MANY PEOPLE THE LAST SIX MONTHS OF LIFE BUT PALLIATIVE CARE IS ANOTHER LAYER OF SUPPORT THAT YOU CAN GET EVEN EARLIER IN YOUR DISEASE. A FEW WORDS ABOUT COPD RESEARCH, IT HELPS US TO UNDERSTAND THE CAUSES OF COPD. THE MECHANISM FOR ITS DEVELOPMENT AND HOW IT IS BEST TREATED. AT LEAST HALF OF THOSE WITH COPD AND THEIR FAMILIES ARE INTERESTING — INTERESTED IN GETTING MORE INFORMATION ABOUT TREATMENT, ESPECIALLY ABOUT THE ADVANCED TREATMENT OF THE ONGOING RESEARCH. TO KIND OF ILLUSTRATE THE IMPORTANCE OF COPD RESEARCH, I WOULD PRESENT TWO STUDIES. THERE IS THE SPIRAL MIX, STANDING FOR SUBPOPULATION INTERMEDIATE OUTCOME MEASURES IN COPD. IT SUPPORTS THE CONNECTION OF THE DISEASE OF MARKERS IN THE BLOOD, GENETIC MARKERS AND CLINICAL DATA FOR PARTICIPANTS FOR THE PURPOSE OF IDENTIFYING GROUPS OF PEOPLE WITH COPD WITH THE SAME CHARACTERISTICS AND SUCH A DIFFICULT TIME GETTING TREATMENT. FOLLOWING PATIENTS. IN THE FIRST STUDY THEY FOUND THAT MORE THAN HALF OF PEOPLE A HISTORY OF SMOKING AND REDUCED LUNG FUNCTION HAD SIGNIFICANT RESPIRATORY SYMPTOMS. MANY OF THESE WERE PRESCRIBED SEO DRUG EVEN THOUGH THEY DID NOT HAVE LUNG OBSTRUCTION ON SPIROMETRY. SO THE FOLLOW-UP STUDY WAS TO UNDERSTAND, DO THEIR SYMPTOMS IMPROVE IF THEY ARE TREATED WITH THESE DRUGS, BRONCHODILATORS? THE STUDY SHOWS THAT IN FACT THE SYMPTOMS DID NOT IMPROVE. SO GIVE YOU MEDICATION THAT DOESN’T HELP YOU, YOU MAY GET AN ADVERSE EVENT. SO WE NEED MORE RESEARCH TO UNDERSTAND HOW A PROTEIN COULD TREAT VARIOUS INNOVATIONS IN AN EARLY STAGE BEFORE THE DAMAGE OF THE LUNG IS SERIOUS. JUST TO UNDERSTAND, THAT’S WHY WE NEED RESEARCH. MAYBE LOGICALLY IT WOULD HAVE BEEN TO KEEP THE PATIENT IN TREATMENT IN THE END THE TREATMENT DID NOT REALLY HELP. NEXT, COVID-19 AND COPD. STUDIES DIDN’T SHOW ANY SIGNIFICANT DIFFERENCE IN THE RATE OF INFECTION BETWEEN THOSE WITH COPD AND THOSE WITHOUT. HOWEVER, PEOPLE WITH COPD HAD HIGHER RATES OF HOSPITALIZATION, ICU ADMISSION, AND DEATH COMPARED TO NON-COPD. PATIENTS WITH COPD SHOULD GET VACCINATED AND GET THE BOOSTER AGAINST COVID-19 AND OF COURSE PATIENTS WITH COPD SHOULD GET THE FLU VACCINE AND THE COVID VACCINE. WHAT ABOUT THE AWARENESS OF COPD? IT’S INCREASED IN THE PAST 10 YEARS, BUT ONE QUARTER, ONE IN FOUR ADULT IN THE U.S. HAVE NEVER HEARD ABOUT COPD. THREE OUT OF 10 HAVE SYMPTOMS THAT GO UNDIAGNOSED AND UNTREATED. CONCERN ABOUT THE GROWING INCIDENCE OF COPD AND OF COURSE THE MILLIONS OF DOLLARS SPENT ON COPD RELATED CARE, MEMBERS OF THE CONGRESSIONAL COPD RELATED CAUCUS URGED THE NATIONAL INSTITUTE OF HEALTH AND CENTER FOR DISEASE CONTROL TO CRAFT A TACKLING OF THE DISEASE. DEVELOPED AT THE REQUEST OF CONGRESS, WITH INPUT FROM THE BROADER COPD COMMUNITY, AND 2017 THE NATIONAL ACTION AND WAS PUBLISHED. IT’S THE FIRST-EVER BLUEPRINT FOR A MULTIFACETED UNIFIED FIGHT AGAINST THIS DISEASE AND IT PROVIDES A COMPREHENSIVE FRAMEWORK FOR ACTION FOR THOSE AFFECTED BY THE DISEASE AND THOSE WHO CARE ABOUT EASING THE PATIENT BURDEN. THE ACTION PLAN IS IN FACT A LIVING DOCUMENT THAT IS NOT STUCK IN TIME. IT’S SUBJECT TO REVISION FOR MINIMIZING THE RISE OF COPD AND YOU CAN FIND IT AT COPD. NAH.GOV. HERE OF THE FIVE MAIN GOALS OF THE COPD NATIONAL ACTION PLAN. THE FIRST IS TO EMPOWER PEOPLE WITH COPD, THEIR FAMILIES AND CAREGIVERS, TO RECOGNIZE OR REDUCE THE BURDEN OF COPD. THE SECOND GOAL IS TO IMPROVE THE CONVENTION, DIAGNOSIS, TREAT AND MANAGEMENT OF COPD BY IMPROVING THE ALDI OF CARE DELIVERED FOR THE HEALTH CARE TO CONTINUE. THE THIRD GOAL IS TO COLLECT, ANALYZE, REPORT AND DISSEMINATE COPD RELATED DATA THAT DRIVES CHANGES AND TRACKS PROGRESS. THE FOURTH GOAL IS TO INCREASE SUSTAINED RESERVE TO BETTER UNDERSTAND THE PREVENTION, DIAGNOSIS, TREATMENT, AND MANAGEMENT OF COPD. LASTLY, THE FIFTH GOAL IS TO TRANSLATE NATIONAL POLICY, EDUCATION, AND PROGRAM RECOMMENDATIONS INTO RESEARCH AND PUBLIC HEALTH CARE ACTION. TO ACHIEVE THE GOALS OF THE NATIONAL ACTION PLAN IT IS IMPORTANT THAT ALL MEMBERS OF THE COPD COMMUNITY GET INVOLVED IN THE PLAN HAS SPECIFIC ACTIONS FOR THE VARIOUS GROUPS, LIKE HEALTH CARE PROFESSIONALS, POLICYMAKERS, RESEARCHERS. PATIENTS AND CAREGIVERS. ADVOCATES AND NONPROFIT. IF YOU ARE A PATIENT, GOALS ONE AND FIVE ARE MOST ACHIEVABLE. IF YOU ARE A HEALTH CARE OFFICIAL, GOALS 1, 2, AND FIVE ARE MOST PERTINENT. A COMMUNITY ACTION TOOL WAS DEVELOPED TO LOOK AT THE PROGRESS THE COMMUNITY HAS MADE THE WE ARE LOOKING AT THE GOALS AND OBJECTIVES. BRINGING IN INFORMATION FROM THE COPD COMMUNITY ABOUT THE TYPES OF ORGANIZATIONS AND ACTIVITY IS RECORDED. YOU SEE THERE ARE SEVERAL PROGRAMS IN THE COMMUNITY ACTION TOOL, INCLUDING THE NETWORK, THE COPD FOUNDATION, LEARN MORE FEEL BETTER PROGRAM FROM THE NIH, AMERICAN LUNG ASSOCIATION, AND MANY MORE. LEARN MORE WITH — LEARN MORE BREATHE BETTER PROGRAM, WANT TO SPEND A FEW MINUTES ON THIS, IT’S A NATIONAL HEALTH EDUCATION PROGRAM THAT AIMS TO BRING VISIBILITY TO LUNG HEALTH BY TRANSLATING RESEARCH INTO EDUCATIONAL PROGRAMS. I ENCOURAGE YOU TO GO ONLINE AND ACCESS THIS PROGRAM. IT PROVIDES A LOT OF FREE RESOURCES ABOUT SYMPTOMS, DIAGNOSIS, TREATMENT, AND MANAGEMENT FOR CAREGIVERS AND PROGRAMS. IT HAS VIDEOS, FACT SHEETS, SOCIAL MEDIA RESOURCES, AND EVERYTHING IS WRITTEN FOR PATIENTS AND SUCH A WAY THAT YOU WILL UNDERSTAND. THERE ARE ALSO RESOURCES FOR HEALTH CARE PROVIDERS. THERE IS A DIGITAL TOOLKIT. PODCASTS AND TEACHING TOOLS FOR HANDING OUT. ADDITIONAL COPD RESOURCES. WE TALKED ABOUT THE LEARN MORE BREATHE BETTER WEBSITE. THERE THE COPD NATIONAL ACTION PLAN. I MENTIONED THAT WE HAVE A CAREGIVER TOOLKIT THAT I ENCOURAGE YOU TO ACCESS IF YOU HAVE A LOVED ONE WITH COPD. I WANT TO END BY SAYING THAT COPD IS CURRENTLY AN INCURABLE DISEASE. IT’’S PREVENTABLE AND TREATABLE. THERE ARE MANY UNKNOWNS ABOUT THE HISTORY OF LUNG FUNCTION AND THE DEVELOPMENT OF COPD, WHICH IS WHY FOUNDATIONS ARE SO IMPORTANT, HOPING THAT WE WILL FIND A CURE IN THE FUTURE AND ALSO BETTER TREATMENT FOR PATIENTS WITH COPD. AND THAT’S WHAT I HAVE.

ANDREA: THANK YOU, DR. STEFAN. I WAS SCRIBBLING NOTES THE ENTIRE TIME. I LEARNED SO MUCH FROM THE PRESENTATION. I THINK THAT ONE OF THE BIGGEST TAKEAWAYS AND FROM SOME IN THE CHAT, THERE’S SO MUCH HOPE FOR PEOPLE WITH COPD. THAT IS A GREAT TAKE AWAY MESSAGE. AND ALL THE RESOURCES THAT YOU LISTED LIKE PULMONARY REHABILITATION AND PALLIATIVE CARE. THIS HAS BEEN A FANTASTIC PRESENTATION AND WE HAVE A FEW QUESTIONS IN THE CHAT. SO I WILL GO THROUGH SOME OF THOSE. SO OUR FIRST IS, AND THIS COULD BE A TRICKY ONE, HOW CAN I HELP MY SPOUSE STOP SMOKING? THAT’S EASIER SAID THAN DONE, CORRECT?

DR. STEFAN: YEAH, IT IS. IT’S A GREAT QUESTION. WHAT I WOULD RECOMMEND IS THE FIRST STEP, UNDERSTANDING THAT PEOPLE WHO SMOKE BECOME ADDICTED TO NICOTINE. THIS IS THE DRUG FOUND IN TOBACCO. THIS CAN MAKE IT HARD TO QUIT. SO WE NEED TO MAKE SURE THAT WE ARE NOT BLAMING ON THE PERSON WHO IS SMOKING. THIS IS AN ADDICTION. RIGHT? TO BE ABLE TO HELP, YOU NEED TO BE INFORMED ABOUT ALL THE RESOURCES FOR SMOKING CESSATION. BECAUSE QUITTING SMOKING IS HARD. IT OFTEN TAKES MULTIPLE ATTEMPTS BEFORE QUITTING FOR GOOD. SO DON’T BE DISCOURAGED IF YOUR LOVED ONE TRIED AND THEN STARTED AGAIN SMOKING. THERE ARE MANY RESOURCES TO HELP YOU IN YOUR SPOUSE. YOU CAN TALK TO A QUIT SMOKING COUNSELOR. IT CAN BE INDIVIDUAL OR IN GROUP. I MENTIONED THE NATIONAL QUIT LINE. WE RECOMMEND ONE, SMOKE-FREE.GOV. THERE ARE FREE TEXTING PROGRAMS AND MOBILE APPS. PEOPLE SOMETIMES SAY ON GOING TO QUIT COLD TURKEY, I CAN DO IT. SOME CAN. MOST CANNOT. WE KNOW THAT THERE ARE MANY OPTIONS AVAILABLE TO HELP A PERSON QUIT SMOKING. WE DISCUSSED GUMS, PATCHES, PRESCRIPTION MEDICINES. SO YOU AS A CAREGIVER WOULD PROMPT YOUR SPOUSE TO TAKE THEM. REMEMBER, EVEN IF THEY TRIED BEFORE, THE KEY TO SUCCESS IS TO KEEP TRYING AND NOT ABOUT. AFTER ALL, MORE THAN HALF OF U.S. ADULTS WHO SMOKE HAVE QUIT. I WANT TO TAKE TWO OR THREE MINUTES. I’M SURE THAT THIS IS A QUESTION AND MANY PEOPLE WHO SMOKE OR HAVE SOMEONE WHO SMOKE IN MIND AND IT’S ABOUT THE E-CIGARETTES. ARE THEY USEFUL FOR QUITTING SMOKING? WE DON’T HAVE A FIRM ANSWER BUT WE KNOW THAT AT THIS TIME, E-CIGARETTES ARE NOT APPROVED BY THE FDA TO HELP PEOPLE QUIT SMOKING. FOR THOSE OF YOU WHO DON’T KNOW EXACTLY, IT’S A BATTERY-POWERED DEVICE THAT PRODUCED ITS AN INHALED PAPER. IT DOES SO BY HEATING A LIQUID THAT USUALLY CONTAINS NICOTINE’S. THE VAPOR IS NOT JUST WATER VAPOR. THEY MAY CONTAIN CHEMICALS AND WE DO NOT KNOW ENOUGH ABOUT THEIR EFFECTS. YOU MAY HAVE HEARD THAT IN 2020 THERE WAS AN OUT MAKE OF DISEASES RELATED TO E-CIGARETTES. THERE ARE A FEW STUDIES WHICH SHOW THAT AMONG THOSE WHO USE E-CIGARETTES TO QUIT SMOKING, IN FACT AFTER A WHILE THEY USE, THEY STILL SMOKE AND USE E-CIGARETTES. THIS WOULD BE SOMETHING THAT WE WOULD NOT RECOMMEND. BUT WE WOULD RECOMMEND SOME OF THE OTHER OPTIONS THAT WE KNOW THE WORK.

ANDREA: THANK YOU. THANK YOU, A GREAT EXPANSION ON THE RUSSIAN THERE, WE DO GET THAT QUESTION A BIT WHERE PEOPLE ASK ABOUT VAPING. ANOTHER QUESTION WE HAVE IN THE VOX, HERE’S ONE FUN COMMENT FOR THE NEXT QUESTION, SOMEONE SAID SINGING IS GREAT LUNG EXERCISE.

DR. STEFAN: YES, THAT’S A GREAT POINT. ON COPD FOUNDATION IN FACT THEY HAVE AN EXERCISE WITH A HARMONICA. I DON’T KNOW IF I PRONOUNCE THAT CORRECTLY?

ANDREA: YES.

DR. STEFAN: SO THERE IS A HARMONICA EXERCISE, STUDY SHOW, YOU ARE RIGHT THE SINGING AND USING THIS TYPE OF DEVICE. IT HELPS YOU KIND OF TAKE A DEEP BREATH AND TRAIN YOUR BREATHING. THANK YOU FOR THAT COMMENT.

ANDREA: I HAD TO LAUGH WHEN I READ THAT BECAUSE I’M ONE OF THOSE WHO WILL ONLY SAYING IN MY CAR OR THE SHOWER BUT I’M SURE THERE ARE BETTER SINGERS OUT THERE. OUR NEXT QUESTION IS WHY YOU MORE WOMEN GET COPD THAN MEN?

DR. STEFAN: YEAH. SO IN THE LAST TWO DECADES, WE KNOW THAT THE PREVALENCE OF THE FREQUENCY OF COPD INCREASED AMONG WOMEN. DUE IN PART TO INCREASED TOBACCO USE AND EXPOSURE. YET IN GENERAL, WOMEN SMOKE LESS THAN MEN. IT MAY BE THAT THEY MAY BE MORE SUSCEPTIBLE THAN MEN. OVERALL WOMEN SMOKERS ARE ABOUT 50% MORE LIKELY TO DEVELOP COPD THAN MEN. THE EXACT REASON FOR SUSCEPTIBILITY FOR WOMEN IS NOT KNOWN. BUT WE ALSO KNOW THAT WOMEN ARE MORE LIKELY TO DEVELOP COPD OF THE SMALL CUBES, THE SMALL AIRWAYS. WHAT IDEA IS THAT THE ARE LIKELY SMALLER THAN THOSE OF MALES FOR THE SAME LUNG VOLUME. SO MAYBE THERE IS A GREATER CONCENTRATION OF TOBACCO SMOKE IN THOSE AREAS. ANOTHER HYPOTHESIS THAT IS NOT PROVED AT ALL IS JUST MAYBE THE METABOLISM OF CIGARETTE SMOKE MAY DIFFER IN WOMEN. THE BOTTOM LINE IS WE DO NOT KNOW FOR SURE IT’S IN THERE ARE SEVERAL STUDIES TRYING TO UNDERSTAND THAT. WHAT WE KNOW IS THAT SOMEHOW WOMEN ARE MORE SUSCEPTIBLE TO COPD IN GENERAL.

ANDREA: I LIKE YOUR COMMENT THERE THAT WOMEN ARE DIFFERENT FROM MEN, WE ARE NOT SMALL MEN. WE DO HAVE DIFFERENT BIOLOGY AND MECHANICS AND EVERYTHING ELSE. ANOTHER QUESTION WE HAVE, IF I AM DIAGNOSED WITH COPD, DOES THAT MEAN I WILL BE STUCK HAULING AROUND AN OXYGEN TANK?

DR. STEFAN: YEAH, THANK YOU FOR THE QUESTION. FINDING OUT THAT YOU NEED SUPPLEMENTAL OXYGEN CAN MAKE YOU SCARED. AND FRUSTRATED. I KNOW. I HAD A FRIEND WHO HAD TO CARRY THE OXYGEN AROUND IN HER FEELING WAS INITIALLY THAT PEOPLE VIEW THEM AS HANDICAPPED. YOU MIGHT THINK THAT IT WOULD BE A HASSLE TO BE CONNECTED TO AN OXYGEN THING AND YOU MAY REALLY THINK ALL THE PLANS YOU HAD AROUND HAVING THE OXYGEN. IF YOU ARE THINKING OR FEELING THIS WAY, REMEMBER THAT OXYGEN THERAPY CAN HELP YOU FEEL LESS TIRED AND LESS OUT OF BREATH. YOU MAY BE ABLE TO DO MORE THAN YOU FOR. IT MAY EVEN HELP YOU LIVE LONGER. SO THAT’S THE FIRST POINT I WANT TO MAKE. THAT YES, THERE WILL BE SOME DOWNSIDE, BUT THIS IS SOMETHING THAT MIGHT HELP YOU WITH THE QUALITY OF LIFE IN THE LONG TERM. IF YOU FOUND THAT YOU NEED OXYGEN, YOU NEED TO TALK WITH YOUR DOCTOR. NOT ONLY ACCEPT WHAT THEY WRITE, BUT ASKED WHAT TYPE OF DELIVERY SYSTEM, DISCUSSING WHAT’S BEST FOR YOU AND YOUR NEEDS. NOT ONLY AT HOME BUT HOW ACTIVE YOU GENERALLY ARE AND HOW CAN YOU PROVIDE TO HAVE THIS OXYGEN IF YOU ARE EXERTING YOURSELF? SO JUST QUICKLY I WANT TO EXPLAIN HOW THIS OXYGEN, THE TYPES OF OXYGEN, THERE ARE TWO TYPES. GASEOUS AND LIQUID, THE SYSTEMS ARE DIFFERENT AND THERE ARE PROS AND CONS FOR EACH. MANY PEOPLE THINK OR SAW THAT IN THE PAST MANY OXYGEN USERS WERE GIVEN A HOME CONCENTRATOR AND A TANK FOR GOING OUT. THE PROBLEM WITH THIS ARRANGEMENT WAS THAT THE PATIENT HAD TO PULL THE TANK ON A CART WHEN GOING OUTSIDE OF THEIR HOME . AND INSIDE THE HOME THE USER COULD ONLY MOVE AS FAR AS THE TWO WOULD GO. HOWEVER, THE TECHNOLOGY HAS ADVANCED AND WE HAVE NEWER TYPES OF OXYGEN SYSTEMS. IN THIS NEWER SYSTEM THE OXYGEN IS PRODUCED BY A CONCENTRATOR AND IS STORED IN A TANK THAT IS REFILLABLE. THE TANKS ARE SMALL AND LIGHT AND YOU CAN EASILY CARRY THEM ON A SHOULDER CASE OR A BACKPACK. THE LENGTH OF TIME IT LASTS VARIES AS WELL DOES HOW MUCH OXYGEN YOU NEED TO. WE WERE TALKING WITH ANDREA BEFORE THIS SESSION THAT SOMEONE ASKED HER ABOUT CONTINUOUS OXYGEN IN THEIR ARE SYSTEMS THAT ARE MORE ADVANCED WHERE SOME OF THEM JUST GIVE OXYGEN CONTINUOUSLY BUT SOME OF THEM GIVE THE OXYGEN ONLY WHEN YOU BREATHE IN. IT ALLOWS THE OXYGEN THAT YOU CARRY TO BE THERE FOR LONGER TIMES. SO THAT YOU CAN GO OUT TIME THIS SYSTEM WILL HELP YOU MOVE AROUND EASIER, INSIDE AND OUTSIDE YOUR HOME AND YOU DON’T HAVE TO RELY ON SOMEONE NEEDING TO REPLACE TANKS WHEN YOU NEED THEM. SO IT PUTS YOU IN CONTROL OF FILLING YOUR OWN TANKS AND YOU CAN EVEN TRANSFER AND MOVE OUT THIS ENTIRE SYSTEM IF YOU DECIDE TO RELOCATE TO A SUMMER HOME. THE LIQUID OXYGEN MODALITY, WHICH IS GOOD FOR THOSE WITH HIGHER NEEDS OF OXYGEN, IT’S STORED IN A RESERVOIR THAT NEEDS TO BE FILLED ON A REGULAR BASIS, BUT YOU CAN STILL USE THE RESERVOIR TO FILL SMALLER CONTAINERS. SO BOTTOM LINE IS THAT IF REEVALUATED, ESPECIALLY AFTER THE FIRST TIME YOU HAVE BEEN PUT ON OXYGEN. IN ABOUT 60 TO 90 DAYS. YOU SHOULD GO TO YOUR PRIMARY CAREGIVER TO SEE IF YOU NEED IT STILL. MAYBE YOU STARTED IT BECAUSE YOU WERE IN THE HOSPITAL AND HAD A LUNG INFECTION AND MAYBE YOU DON’T NEED IT ANYMORE AND IF YOU MEET IT, JUST MAKE SURE THAT YOU HAVE A SYSTEM THAT WILL HELP YOU BE AS INDEPENDENT AS YOU CAN WHILE REMEMBERING THAT THIS HELPS YOUR QUALITY OF LIFE AND LONG-TERM PROGNOSIS.

ANDREA: THANK YOU THANK YOU, THAT WAS A GREAT ANSWER TO THE QUESTION AND I REALLY LIKE HOW YOU FOCUSED ON USING THE OXYGEN IF YOU NEED IT AND IT WILL HELP YOU FEEL BETTER AND HELP YOU TO BE ABLE TO DO MORE THINGS WITH YOUR LIFE AND HAVE A BETTER QUALITY OF LIFE. SO THANK YOU, THANK YOU.

DR. STEFAN: IT’S AN IMPORTANT THING FOR EVERYONE WHO HAS IT.

ANDREA: YES, YES, ABSOLUTELY. THE NEXT QUESTION IS — IS PULMONARY REHABILITATION ONLY FOR COPD? I HAVE HEARD THAT PEOPLE WITH ASTHMA AND LUNG COVID HAVE NEEDED IT. — LONG COVID HAVE NEEDED IT.

DR. STEFAN: AS WE’VE DISCUSSED, EXERCISE IS DESIGNED TO HELP PEOPLE WITH CHRONIC LUNG DISEASES. ANY PERSON WITH A CHRONIC LUNG DISEASE MIGHT BENEFIT FROM CULINARY REHAB. WE KNOW THE MOST ABOUT COPD FROM THOSE WITH LUNG CANCER, LUNG CANCER SURGERY, PULMONARY HYPERTENSION, AND MORE RECENTLY TESTED FOR LONG COVID, WE KNOW THAT IT MAY NOT CURE YOUR LUNG DISEASE BUT YOU MAY NOTICE YOUR BREATHING PROBLEM IMPROVES, IMPROVES QUALITY OF LIFE. IN SUMMARY YES IS NOT ONLY FOR PEOPLE WITH COPD. ALSO OTHER CONDITIONS. MAKE SURE THAT IF YOU HAVE COPD OR THIS OTHER CONDITION, ASK YOUR HEALTH CARE TEAM IF PULMONARY HELP IS APPROPRIATE FOR YOU.

ANDREA: I HAPPEN TO BE ONE OF THOSE PEOPLE WITH ASTHMA AND LONG COVID AND I DIDN’T PULMONARY REHAB WAS FOR ME. I THOUGHT IT WAS JUST FOR PEOPLE WITH COPD AND IT MADE A BIG DIFFERENCE IN MY IMPROVEMENT. I’M JUST GOING TO THROW THAT OUT THERE. OUR NEXT QUESTION IS I THOUGHT PALLIATIVE CARE WAS ONLY FOR PEOPLE WHO WERE DYING. MOST PEOPLE THINK THAT. PROBABLY WITHIN A FEW MONTHS. THAT’S WHAT THEY ARE LIKELY REFERRING TO.

DR. STEFAN: RIGHT, I KNOW. I HAVE A DISCLOSURE, I WAS A PALLIATIVE CARE DOCTOR. I WOULD SAY THAT I KIND OF KNOW A LITTLE BIT MORE ABOUT THIS. I WANT TO MAKE SURE THAT WE MAKE THESE DISTINCTIONS BETWEEN PALLIATIVE CARE AND HOSPICE. BECAUSE PEOPLE WRONGLY BELIEVE THAT IT’S ONLY FOR PEOPLE WHO ARE CLOSE TO DYING. PALLIATIVE CARE IS I SAID IS CALLED ALSO SUPPORTIVE CARE AND IS KEY IN MANAGING COPD. IT’S FOCUSED ON HELPING YOU ACHIEVE BEST QUALITY OF LIFE AND IS APPROPRIATE FOR ALL PEOPLE WITH COPD, REGARDLESS OF STATE OR PROGNOSIS. JUST THINK OF PALLIATIVE CARE LIKE AN EXTRA LAYER OF SUPPORT THAT FOCUSES ON YOUR NEEDS AND RELIEF FOR SYMPTOMS STRESSING THE DISEASE. INCLUDING THERAPIES TO RELIEVE THE DISCOMFORT, THE SHORTNESS OF BREATH OR ANXIETY, EDUCATION ABOUT LIFESTYLE CHANGES DURING COPD, MEDICATION AND BUSINESS MANAGEMENT, AND THE PALLIATIVE CARE TEAM WORKS IN PARTNERSHIP WITH YOUR OWN DOCTOR TO PROVIDE SUPPORT FOR YOU AND YOUR FAMILY. THINKING OF THE HOSPICE, HOSPICE IS INDEED FOR ITS INDICATED FOR THOSE WHO WE THINK HAVE SIX MONTHS OR LESS OF LIVING. BUT COPD IS HARD, COPD IS A CHRONIC CONDITION. PATIENTS CAN BE IN THE HOSPITAL ON A MECHANICAL EVENT AND THEN LIVE ANOTHER SEVERAL YEARS. IT’S HARD TO PREDICT. IT’S NOT THAT IF YOU GO TO HOSPICE IT MEANS THAT YES, THE END IS NEAR. THAT’S NOT THE CASE. UNFORTUNATELY, PEOPLE ACCESS HOSPICE VERY LATE, EVEN FOR THOSE WHO HAVE VERY ADVANCED DISEASE. IT’S JUST IN THE LAST TWO WEEKS OF LIFE, WHEN THEY LOSE ALL THIS ADDITIONAL SUPPORT. BECAUSE THE HOT IS NOT ONLY A GROUP OF DOCTORS AND NURSES THAT ARE 24 HOURS ON CALL, BUT THEY HAVE VOLUNTEERS. IT’S A LOT OF SUPPORT FOR THE FAMILIES GOING THROUGH DIFFICULT TIMES.

ANDREA: THANK YOU FOR TALKING MORE ABOUT THAT. WE HAVE TIME FOR MAYBE THREE MORE QUESTIONS. ONE, MY WIFE WAS DIAGNOSED WITH COPD AND I’M HER MAIN CARETAKER. I DO NOT KNOW WHERE TO GO FOR HELP.

DR. STEFAN: YEAH, THAT’S HARD. CARING FOR SOMEONE WITH COPD IS COMPLICATED. I WOULD SAY THAT THE FIRST STEP IS TO UNDERSTAND MORE ABOUT THE CONDITION. IT IS GOOD TO KNOW WHAT MIGHT BE A SYMPTOM OF COPD AND WHAT MIGHT BE A SYMPTOM OF A DIFFERENT CONDITION. PEOPLE WITH COPD TAKE A NUMBER OF MEDICATIONS. IT’S IMPORTANT TO KNOW WHAT THE MEDICATIONS ARE, WHEN TO USE THEM AND HOW TO TAKE THEM SO THAT YOU CAN PROVIDE BETTER CARE FOR YOUR SPOUSE. I MENTIONED THIS BEFORE BUT THE NATIONAL INSTITUTE OF HEALTH ASSOCIATION AND THE LEARN MORE BREATHE BETTER PROGRAM DEVELOPED THE COPD CARE TOOLKIT TO HELP THE CAREGIVERS OF PEOPLE WITH COPD AND I WOULD ENCOURAGE YOU TO GO ON THE SITE AND DOWNLOAD THE INFORMATION. THEY WILL BE VERY HELPFUL. IN MY MIND OF THE FIRST STEP IS YOU NEED TO UNDERSTAND THIS DISEASE SUCH THAT YOU CAN BE OF HELP AND SUPPORT THEM IN THEIR QUEST FOR TO QUIT SMOKING OR HOW TO TAKE THEIR MEDICATION OR JUST TO UNDERSTAND WHAT TO DO IF THEY HAVE, IF THEY HAVE SYMPTOMS. DEVELOPING A PLAN AND THINKING, WE ARE GOING TO THE DOCTOR AND WE HAVE TO HAVE SOME QUESTIONS WRITTEN DOWN TO ASK, TO ASK THE DOCTORS. FINDING THIS CAREGIVER TOOLKIT WILL HELP YOU BECAUSE IT HAS STANDARDIZED WHAT YOU NEED TO KNOW IN WHAT YOU HAVE TO DO.

ANDREA: THAT’S, THAT’S A GREAT RESOURCE. IN FACT WHEN WE SENT IN EMAIL OUT — SEND ANY MAIL OUT A COUPLE OF DAYS AFTER THE WEBINAR, WE WILL SEND ALL OF THESE RESOURCE LINKS OUT TO YOU AND IT’S A GREAT OPTION FOR PEOPLE WHO JUST DON’T KNOW WHAT THEY DON’T KNOW. SO, GREAT RESOURCE. WE HAVE ANOTHER ONE AND THIS IS PROBABLY GOING TO BE OUR LAST QUESTION. WE MIGHT HAVE TIME FOR ONE MORE. IF I HAVE COPD, SHOULD I GET VACCINES, SHOULD I GET THE COVID-19 VACCINE?

DR. STEFAN: OH ABSOLUTELY, YES. I HAVE NO DOUBT ABOUT THIS. YOU SHOULD GET THE BOOSTER. THE BIVALENT WITH THE VACCINE AND THE BOOSTER, ITS INDICATED BECAUSE THE BOOSTER THAT HAS THE TWO VARIANTS, THAT’S WHERE THE TWO VARIANTS ARE INDICATED FOR THOSE WITH THE CONDITION. THOSE OVER 58 OR WITH A SERIOUS CONDITION LIKE COPD. WE KNOW THAT THOSE WHO WERE VACCINATED WERE LESS LIKELY TO BE HOSPITALIZED AND DIE. I CAN TELL YOU FROM MY PERSONAL EXPERIENCE, I JOINED NIH IN MARCH BEFORE THAT WAS AT A HOSPITAL. I WORKED THROUGH THIS TIME WHEN COVID WAS THERE. WE EVEN, WE KNOW THIS MORE FROM STUDIES BUT EVEN IN THE HOSPITAL, WE SAW THAT THERE WAS A DIFFERENCE IN THE SEVERITY OF ILLNESS BETWEEN THOSE WHO WERE VACCINATED AND WHO WERE NOT. IN ADDITION TO THE, TO THE COVID VACCINE OF COURSE, WE SHOULD GET THE FLU VACCINE. HOPEFULLY YOU GOT IT THIS YEAR. ALSO, THE PNEUMOCOCCAL VACCINES.

ANDREA: EXCELLENT. THANK YOU, THANK YOU. LAST QUESTION, SOMEONE ASKED IS IT NORMAL OR CAN IT HAPPEN THAT SOMEONE YOUNGER THAN 40 WHO HAS BEEN A SMOKER, CAN THEY GET COPD EVEN AT A YOUNGER AGE?

DR. STEFAN: I WAS TALKING EARLIER ABOUT THIS DISEASE, WHICH IS CALLED ALPHA-1. FOR SOMEONE WHO WAS NOT A SMOKER , THE SMOKING WOULD MAKE THE DISEASE TO COME QUICKER. SOMEONE WITH THIS CONDITION IS MORE LIKELY TO DEVELOP COPD AT A YOUNG AGE. EVEN IN THE ABSENCE OF SMOKING. EVEN IN THE ABSENCE OF ANY OTHER RISK FACTORS. IF YOU OR SOMEONE YOUR — YOU KNOW WAS DIAGNOSED WITH COPD AT A YOUNG AGE, MAKE SURE THEY ARE TESTED FOR THE ALPHA-1. IN FACT I WANT TO EMPHASIZE AGAIN THAT THE GUIDELINES WE HAVE RIGHT NOW IS THAT ANYONE SHOULD BE TESTED FOR. IT’S AN EASY TEST, IT’S A BLOOD TEST. YOUR PRIMARY CARE CAN ORDER IT WITH YOUR REGULAR BLOOD TEST AND IT’S IMPORTANT. IT’S NOT FREQUENT BUT WE DON’T DIAGNOSE THIS ENOUGH. AND IF SOMEONE HAS IT, WE HAVE A SPECIFIC MEDICATION TO SLOW THE PROGRESSION THAT WE DON’T HAVE FOR SOMEONE, FOR THE OTHER COPD.

ANDREA: THANK YOU, THANK YOU. THAT WAS A GREAT EXPLANATION ON THAT. WE HAD SOME PEOPLE EARLIER ASKING ABOUT ALPHA-1, HOW TO GET TESTED AND HAVE YOUR INSURANCE COVERS IT. THEY CAN ORDER IT WITH OTHER BLOOD TESTS. AS WE KNOW, EVERY INSURANCE COMPANY IS DIFFERENT AND IT DEPENDS ON WHAT THEY WILL COVER. IF YOU CAN GO FOR JUST ONE OR TWO MORE SLIDES, WE HAVE A WEBINAR. WE HAVE THE FREE SIX-WEEK COPD EDUCATION PROGRAM THROUGH ALLERGY AND ASTHMA NETWORKS. AS I MENTIONED, IT’S FREE. WE HAVE THAT IN ENGLISH AND SPANISH AND THERE ARE INCENTIVES AVAILABLE FOR ANYONE WHO WANTS TO PARTICIPATE IN THAT. WE WILL INCLUDE THE LINK IN THE INFORMATION WE SEND OUT AFTER THE WEBINAR. LET’S DO ONE MORE SLIDE. THIS WILL BE THE WEBINAR NEXT WEEK. IS IT ENVIRONMENT OR GENETICS. WE WILL BE ABLE TO OFFER CEU’S NEXT WEEK ON THIS, VALENTINE’S DAY, THE 14TH. YOU SHOULD HAVE THE INFORMATION TO BE ABLE TO REGISTER FOR THAT. I CANNOT THANK YOU ENOUGH, DR. STEFAN, I HAVE LEARNED SO MUCH FROM YOU AND I HAVE A WHOLE PAGE OF NOTES. THANK YOU AGAIN FOR JOINING US. THIS IS ANDREA JENSEN AT THE STAFF FOR THE ALLERGY AND ASTHMA NETWORK. THANK YOU FOR JOINING US EVERY DAY AS WE WORK TO BREATHE BETTER TOGETHER.

DR. STEFAN: THANK YOU FOR INVITING ME.