Online Health Chat with Umur Hatipoglu, MD and Samuel Gurevich, MD

Wednesday, March 23, 2016

Description

Chronic obstructive pulmonary disease (COPD) is a lung disease and the third leading cause of death in the United States. More than 11 million people have COPD. People with COPD have chronic bronchitis, emphysema or both. Most adults diagnosed with COPD are long-time cigarette smokers, and smoking is a major cause of the disease. Another important cause of COPD is alpha 1-antitrypsin deficiency, an inherited disorder that can interfere with normal lung function.

About the Speaker(s):

Umur Hatipoglu, MD, has been a staff member in the Respiratory Institute at Cleveland Clinic's main campus since September 2008. Prior to that appointment, he served as the chief of pulmonary and critical care medicine at Mercy Hospital and Medical Center in Chicago and was appointed clinical associate professor of medicine at the University of Illinois at Chicago. Dr. Hatipoglu also serves as the quality improvement officer of the Respiratory Institute. His clinical interests include asthma, acute respiratory distress syndrome, general (diagnostic) pulmonary medicine and critical care medicine.

Samuel Gurevich, MD, is a pulmonologist in the Department of Pulmonary Medicine at Cleveland Clinic Florida. He attended Brown University School of Medicine and completed his residency at Yale University. He then went on to complete two fellowships at Jackson Memorial Hospital and Mount Sinai Medical Center. Dr. Gurevich has board certifications in internal medicine, pulmonary disease, critical care medicine and sleep medicine. His special interests are in sleep disorders and pulmonary diseases including COPD, asthma, lung cancer and interstitial lung disease.


Let’s Chat About COPD


Finding and Preventing COPD

marie15: What are the symptoms of COPD? How is it diagnosed?

Umur_Hatipoglu: The most common symptoms of COPD are cough, sputum production and shortness of breath, particularly during exertion. However, the diagnosis of COPD is made by a pulmonary function test called spirometry. In anyone with symptoms or risk factors (family history, occupational exposure and, of course, smoking), spirometry should be done.

memoryway999: How can we prevent COPD before we can detect the symptoms of this illness?

Samuel_Gurevich: COPD is caused by a toxic trigger (most commonly in this country, smoking) along with having a genetic predisposition (something in your genes that makes you susceptible to getting COPD). It can be prevented by avoiding tobacco (including secondhand smoke) and other air toxins. It is detected by a special set of breathing tests (pulmonary function tests) and is supported with other suggestive signs and symptoms. See your primary care physician or pulmonologist for more information.

memoryway999: Do diet and nutrition play a role in the prevention of COPD?

Samuel_Gurevich: While diet and nutrition are extremely important for your overall health, there has not been any conclusive evidence that certain supplements or dietary plans can prevent COPD. Having said this, the healthier a person is, the more they are able to tolerate and work through medical problems including COPD.

ellie7: Is there any way to slow down, reverse or stop progression of COPD? I heard using a stationary bike is very helpful.

Umur_Hatipoglu: The only way to stop the progression of COPD is smoking cessation. Exercise is an important part of management; however, it does not slow down the rate of lung function decline.


Most Common Causes

jviolets: I have never smoked, but COPD is in my family history. How much does this increase the likelihood that I will develop COPD? I know smoking is one of the biggest causes, but can I still get it if it runs in my family.

Umur_Hatipoglu: There is a genetic condition that predisposes to COPD called Alpha-1 Antitrypsin Deficiency. Do you have any history of this in the family? You may consider discussing with your doctor to determine whether you need pulmonary function testing and a special blood test to look for this genetic disorder if indicated. The good news is that most people who have the condition will avoid getting COPD if they are able to avoid smoking and other noxious exposures.

rwerther: If I have been exposed to a lot of secondhand smoke, does this increase my risk for COPD? My parents smoked in the house when I was younger, and I am worried about lung diseases.

Umur_Hatipoglu: The latest studies suggest that secondhand smoke exposure may increase the risk of COPD, particularly among women. If you have symptoms of COPD, you may want to be evaluated by a physician and have a spirometry performed.


Talking About Treatment

constance marie: I have COPD and emphysema. I’ve been using two inhalers for the past seven years: Spiriva first thing in the morning and Dulera two times a day. My question is, how can I tell if the Dulera is still working the way it should? I forgot to use it a few times but did use my Spiriva those days. When I realized I had forgotten to use my Dulera, I started using it on a regular basis again. Which is a better alternative inhaler for Dulera? I tried Advair when I was first diagnosed, and I had issues with it so they switched me to Spiriva.

Samuel_Gurevich: A few days are typically too soon to tell if one is working better than the other. Dulera has two types of “controller” medications in it that are meant to prevent your breathing from getting worse. They are very different from the controller medication in Spiriva and are often used together with Spiriva to get maximal benefit. Typically, we try to minimize the number and types of medications patients take to achieve the most benefit for the least side effects. There are other options to Dulera, and adjusting this medication depends on symptoms, your breathing test results and other risk factors. I recommend that you speak with your pulmonologist (lung doctor) to help you make those decisions.

Jmireton: I'm currently using both Advair and Spiriva to treat my COPD. Together, they seem to be working well, but the downside is the cost. They are quite expensive. Are there any less expensive solutions available or in the works?

Samuel_Gurevich: Those medications work well together to address symptoms of COPD, but you are absolutely correct in that the cost can be prohibitive. Both have alternative brands that do the same thing. If you have insurance, they may have a preferred alternative that may be cheaper but have the same effects. Call your insurance company or pharmacist and ask. If you have to pay for medications out of pocket, the drug companies often have patient savings programs accessible from their web sites. Finally, while there are no direct generic alternatives for all the components in these medications, there may be other combinations that are less expensive. Ask your doctor or pharmacist.

tgriffin: What is pulmonary rehabilitation? How can it help with COPD?

Samuel_Gurevich: Pulmonary rehabilitation is a very important part of treatment for COPD. It helps patients with symptoms, and many times improves their ability to do more physical activity. This is true even if patients are using oxygen. It is performed in a controlled manner with professional supervision, which also makes it safe.


Particular Parameters

pan: I am a 62-year-old male. I have a BMI of 23. I smoked for 40 years and quit 10 months ago. I exercise frequently and eat healthy. These are my test results: Spirometry Nov. 2015, six months after quitting = FEV1/FVC=62 AND FEV=80% . I had never had a chronic, productive cough and never had wheezing or was tired. My doctor can’t hear chest wheezes. Here are my questions:
1. Do I have COPD and, if yes, can it be reversed?
2. I don’t take drugs. Must I take them?
3. What is the prognosis for that situation?
4. Can my spirometry values improve over time?

Umur_Hatipoglu: COPD is diagnosed based on a post-bronchodilator FEV1/FVC ratio of < 0.7. We need to know your post-bronchodilator value to be sure of the diagnosis. I think you have done a marvelous job quitting smoking after 40 years. Congratulations! Even if you have COPD, your FEV1 percentage suggests it is of mild severity. You are definitely on the right track exercising and eating well. You may not need any medications unless you have symptoms.

sinaihospital: I am still coughing a lot; does it mean I still have COPD? What can I do for this coughing?

Samuel_Gurevich: COPD is not a disease that you can stop having. It is a chronic illness that can be controlled but does not get cured. While coughing can be a sign that COPD is not well controlled, there may be other factors involved and other reasons for the cough. A breathing test (pulmonary function tests) can help determine the extent of COPD, and your symptoms determine if you need to be on other special medications for it. Of course, not smoking (including secondhand smoke) is also key to slowing down the progression of COPD.

ellie7: My COPD started after heart valve surgery. Is there a connection? My only symptom is shortness of breath, making it hard to walk more than 25 feet without stopping.

Umur_Hatipoglu: It is unlikely that COPD would be related to valve surgery. The severity of your symptom is quite concerning, and I wonder whether there may be other reasons for it. Please consult with your doctor.


Looking Ahead

Jmireton: Could you give us any ideas of where this is headed, what type of research is being done (for a cure or to improve way of life)?

Samuel_Gurevich: There are a number of different medications in the pipeline, including drugs that work very differently from current medicines. There are also different delivery systems that make the medicines easier to take (including aerosols), which allow more of the medicine to reach the lungs. There are also studies with gene research (i.e. stem cells) in regard to helping COPD patients in the future, but this is likely to be useful some time from now. Finally, there is research regarding different procedures and surgeries that may decrease the burden of COPD, taking out or helping circumvent the "bad" part of the lung so more breathing can take place in the less affected parts of the lung.

Umur_Hatipoglu: I think there is room for optimism. Over the past decade, various inhaled medications were shown to reduce the rate of exacerbations, reduce symptoms and improve quality of life. In emphysema, lung volume reduction surgery in a selected group of patients was shown to improve survival. There are newer techniques that are less invasive (performed via bronchoscopy) that are being evaluated, which may improve quality of life for emphysema patients. A cure does not appear to be around the corner. Regeneration of lung tissue has been achieved in animals; however, human studies are awaited. Clearly, the nihilism of earlier days is over.

memoryway999: The World Health Organization has identified that "more than three million people died of COPD in 2012, which is equal to six percent of all deaths globally that year. More than 90 percent of COPD deaths occur in low- and middle-income countries. The primary cause of COPD is tobacco smoke (through tobacco use or second-hand smoke). So, given all of the information from WHO, can you recommend any medical interventions to help improve this situation with this health crisis?

Samuel_Gurevich: You are absolutely correct that COPD is a world crisis, causing significant symptoms and leading to premature death in many people. You are also correct that tobacco use and other air pollutants are the root causes and that the poor are disproportionately affected. Tackling this problem is difficult and requires cooperation from government, health and industry leaders. Find out how you can get involved at your local government level, including participating in education campaigns regarding the ill effects of smoking, especially in young people. At a personal level, educate your family, friends and coworkers, and help them make the healthy choice.


Closing

That is all the time we have for questions today. Thank you, Dr. Hatipoglu and Dr. Gurevich, for taking time to educate us about COPD.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at my.clevelandclinic.org.


For Appointments

To make an appointment with Umur Hatipoglu, MD, or any of the other specialists in Cleveland Clinic’s Respiratory Institute, please call 216.444.6503, or toll-free at 800.223.2273 (ext. 46503).

To make an appointment with Dr. Gurevich or any other specialists in the Department of Pulmonary Medicine at Cleveland Clinic Florida, please call 877.463.2010. You can also visit us online at clevelandclinic.org/florida/ for more information.


For More Information

Cleveland Clinic Health Information

To learn more about symptoms, causes, diagnostic tests and treatments for COPD, visit us at clevelandclinic.org/respiratory.

Clinical Trials

For additional information about clinical trials, visit: ClinicalTrials.gov.

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