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Gabby Cinnamon (Host): Riverside Healthcare, puts the health and wellness information you need well within reach.

Welcome back to the Well Within Reach podcast brought to you by Riverside Healthcare. I'm your host, Gabby Cinnamon. And today, Dr. Shashvat Sukhal, a pulmonologist and critical care specialist at Riverside is joining us to talk about COPD. Thank you so much for coming on the podcast today, Dr. Sukhal. So for our listeners who don't know you, can you tell us a little about your background?

Dr Shashvat Sukhal: Sure. I trained medicine in the Armed Forces Medical College in India. And then I did my residency in internal medicine in the Cook County Hospital at Chicago. I did my fellowship in pulmonary critical care in Cook County, Chicago as well. I then worked in Cook County, Chicago for about three and a half years and then I joined Riverside in December of 2020.

Gabby Cinnamon (Host): Very cool. So you've been here for a little over a year now.

Dr Shashvat Sukhal: Right.

Gabby Cinnamon (Host): We can kind of get into today's topic, which is COPD or chronic obstructive pulmonary disorder. Many people who have COPD don't realize that they have it. Can you kind of explain what COPD is?

Dr Shashvat Sukhal: Right. So like you said, the letters stand for chronic obstructive pulmonary disease or disorder. What it really is is lung damage, which is inflammation of the lungs, narrowing of the airways and destruction of the air sacs which exchange oxygen. So overall, it's basically lung damage, which leads to inflammation and destruction.

Gabby Cinnamon (Host): So what are some of the symptoms associated with COPD that people should look out for, especially if they might have it and don't know that they have it.

Dr Shashvat Sukhal: Sure. Yeah. A lot of times COPD is what we call an insidious disease. Most people don't realize that they have it and it might start off as a smoker's cough. Sometimes you have some wheezing, some shortness of breath, and most of the times, people don't realize it until it gets too late. And then they have severe shortness of breath, especially when they walk. Some of the other symptoms of COPD can be attacks where you can have cough and wheezing and shortness of breath to the point where you can't even walk more than a few feet and you need to go to the hospital. But most often, it just starts off as a chronic nagging cough that just doesn't go away.

Gabby Cinnamon (Host): Wow. So it sounds like something, you know, that if you're concerned or you think you might have it, that you should get care right away and get it treated. How would COPD be diagnosed?

Dr Shashvat Sukhal: The way COPD is diagnosed is first by an assessment by a clinician. So this would be a doctor who would check your symptoms and listen to your lungs. That's where we'd suspect COPD. The confirmatory test for COPD is something called a pulmonary function test, which is a breathing test that's done in the pulmonary function laboratory. What they check for is how well air moves in and out of your lungs and what your lung volumes are. And based on those results, we can tell whether you have COPD or not.

Gabby Cinnamon (Host): So when you talked about symptoms, you mentioned a smoker's cough being kind of a starting symptom. Can you talk about who is at risk for COPD? Is it just people who smoke or can other people be at risk too?

Dr Shashvat Sukhal: That's a good question. Most often, COPD is exclusively a disease of smokers, but any kind of smoke exposure can lead to COPD. And some of the other situations that can lead to COPD are if people around you smoke, if you're involved in occupations that expose you to a lot of smoke or dust. But most often, there is some degree of genetic susceptibility to the disease. There are a lot of smokers who have COPD sooner than other people. A lot of people think that while so-and-so has been smoking for 40 years doesn't have anything, and I just smoked for 20 years and I'm coughing. Well, there's a lot of differences in how different people react to cigarette smoke or any other kind of smoke. But the biggest risk factor is people who smoke and people who have a family history of COPD.

Gabby Cinnamon (Host): What steps would you say that someone can take to reduce their risk for COPD?

Dr Shashvat Sukhal: Well, the biggest step is stopping smoking. So if you don't smoke, then don't smoke. If you smoke, then stop. And if you think stopping is too hard, then cut down, but the best thing to do to reduce your risk is avoid smoke exposure.

Gabby Cinnamon (Host): So if you think you have COPD, what should you do next? You know, maybe you're noticing a cough, like when should you get medical care for that?

Dr Shashvat Sukhal: Well, the first thing you should do if you think you have COPD is reach out to your doctor and schedule an exam. Discuss your symptoms with your doctor. It could be anyone, it could be a general practitioner, or it could be a pulmonologist. Based on your symptoms and your physical exam, if your doctor thinks that you do have COPD, he'll go ahead and order a breathing test. And that's how we'll find out.

Gabby Cinnamon (Host): So earlier you mentioned that it can start off as a cough and then go to breathing problems and then, soon enough, you know, you're walking and you're starting to get out of breath and, you know, needing to go to the hospital. What happens if COPD is left untreated?

Dr Shashvat Sukhal: Well, if COPD is left untreated, it will definitely progress. Most people get cough and shortness of breath on a daily basis. That goes on to not being able to walk more than a few steps. You have limitations in your day-to-day activities. It progresses to needing hospitalization for attacks of cough and shortness of breath. Some people in the advanced stages of COPD need supplemental oxygen. Others need ventilators to breathe at night. Eventually, you start losing weight, your muscles atrophy. In the end stages of COPD, your carbon dioxide levels in the blood go higher, your oxygen levels go lower and it can lead to severe morbidity and death.

Gabby Cinnamon (Host): Wow. So it sounds like it can escalate pretty quickly if you leave it untreated.

Dr Shashvat Sukhal: It can. Correct.

Gabby Cinnamon (Host): So, let's say someone does reach out to get medical care for COPD, what treatments are available? Does the treatment vary on what stage it's in or how advanced COPD is?

Dr Shashvat Sukhal: Correct. So based on the breathing test, the treatment is stratified into stages. So stage I, stage II, stage III and stage IV. There are combination of inhalers, which can help manage symptoms. the only two treatments, which prolong life in COPD are stopping smoking and using oxygen if you need oxygen. There are other treatments like pulmonary rehabilitation, which is an exercise program, which prevents atrophy of the muscles, which trains the lungs to breathe better. Some of the other treatments of COPD are surgical or procedural, such as placing valves to reduce hyperinflation or doing lung volume reduction surgery or, ultimately, lung transplant.

Gabby Cinnamon (Host): So if someone has COPD, let's say, and then they make some lifestyle changes like quitting smoking or cutting back significantly, can COPD be cured, I guess is kind of what I'm trying to ask? Or, once you have COPD, even if you make lifestyle changes, will you still have some of those effects from having it?

Dr Shashvat Sukhal: Well, once you have COPD, there's no cure for it. If you make lifestyle changes such as quit smoking, you can delay the progression of the disease, but it will not cure the damage that's already happened. So once diagnosed, you always have it. The only definitive cure, if you can call it a cure, is lung transplant. But obviously that's, pretty extreme.

Gabby Cinnamon (Host): Yeah. So it sounds like the best thing to do would be just don't start smoking in the first place to avoid that risk.

Dr Shashvat Sukhal: Absolutely.

Gabby Cinnamon (Host): Is there anything else we should know about COPD?

Dr Shashvat Sukhal: Well, COPD is commoner than we think it is. It's quite frequently undiagnosed. Most people who have it don't realize that they have it until it starts to interfere with their day-to-day lives. So if you've been smoking and you smoke cigarettes regularly, it is absolutely very, very important to get screened and tested for COPD.

Gabby Cinnamon (Host): Thank you so much for coming on the podcast today, Dr. Sukhal. This was very informative and I think something very important, especially since so many people do have COPD and don't know that they have it and it can become very dangerous. So thank you so much for sharing all this information with us.

Dr Shashvat Sukhal: Absolutely. Thank you. My pleasure.

Gabby Cinnamon (Host): And thank you listeners for tuning in to the Well Within Reach podcast, brought to you by Riverside Healthcare. For more information about COPD in Riverside's team of pulmonologists, visit riversidehealthcare.org.