Ep03: Taking Control of COPD: Medication and Pulmonary Rehabilitation

Episode Transcript

Dr. Mina Pirzadeh: If someone is first diagnosed with COPD and does not require oxygen, if they quit smoking, if they take away the causative agent, it should not get any worse and it should not progress.

Micaela Arneson: COPD or chronic obstructive pulmonary disease is a lifelong condition, but that doesn't have to be a progressive one. 

John Linnell: We patients need to have good adherence to our medication. We need to stay active. We're equal partners in care with our physicians. 

Micaela Arneson: So if you've recently been diagnosed with COPD or know someone who has and are wondering what now, welcome to this episode of the COPD podcast with me, Michaela Arneson. If you've jumped straight to this episode, we recommend you go back to the beginning and listen to them in order.

In this episode, we'll learn how people with COPD can prevent their condition from getting worse and what first line treatments, medications, therapy, and other interventions are often prescribed after diagnosis.

Stephanie Williams: We just have to find interventions that are helpful for each individual. It's not a one size fits all answer.

Micaela Arneson: Also, stay tuned to the end and we'll share a list of resources where you can learn more. A quick note before we get started. 

This series is for educational purposes only. It is not a substitute for formal medical advice, diagnosis, or treatment. So if you have questions, talk to your qualified healthcare provider.

In the previous episode, we talked about smoking, which is the biggest risk factor for COPD. So yeah, if you're a smoker with COPD, you're going to want to find a way to stop. But beyond smoking cessation, people with COPD can be prescribed medication to make their breathing easier and reduce the severity of their symptoms.

Mike Hess: The first thing that you're probably going to try once you're diagnosed with COPD is some kind of inhaled medication.

Micaela Arneson: Inhaled medication can be delivered in the form of an inhaler or a nebulizer, which sprays liquid medicine in a fine mist that you breathe in. One type of inhaled medication is called a bronchodilator.

Mike Hess: All of your airways in your lungs have small muscles around them and a bronchodilator helps those muscles relax a little bit better so that you can get better air movement in and out. 

Micaela Arneson: And there are different kinds of bronchodilators that work differently to ease breathing.

Mike Hess: We have longer-acting medications that we sometimes call controllers or maintenance meds. These are things you take every day no matter how you feel. Of course, sometimes you need those shorter-acting relievers, sometimes they're even called rescue medications. 

Micaela Arneson: Symptoms can suddenly become worse in what's known as an exacerbation or a flare up. This is often due to external factors like a cold, bacterial infection, pollen, or air pollution. And that's where a short acting or rescue inhaler will be used. They last between four and six hours, whereas long lasting inhalers are good for between 12 and 24 hours. 

Mike Hess: The reliever you should have with you all the time because you can't always predict what your trigger is going to be and you can't always predict where you're going to run into it.

Micaela Arneson: But bronchodilators aren't the only kind of inhaled medication that can improve symptoms of COPD.

Dr. Mina Pirzadeh: If that's not enough, we sometimes need to add additional inhalers that have inhaled steroids. 

Micaela Arneson: Meet Dr. Mina Pirzadeh.

Dr. Mina Pirzadeh: I am an assistant professor in pulmonary and critical care medicine at the University of Michigan Medical School, and I practice here in Ann Arbor, Michigan. Now the inhaled steroids are just going and staying inside the lung. That again, reduces inflammation, it allows the airways to be more open and hopefully allow the patient to breathe easier. 

Micaela Arneson: Like smoking cessation, there is no one size fits all answer when it comes to treatment. What works for one person might not work for another.

Dr. Mina Pirzadeh: Deciding which inhaler to use really depends on the severity of the patient's symptoms, not only shortness of breath, but also cough and phlegm production, sleep quality, exercise limitation, and energy levels. 

Micaela Arneson: And many people with COPD will be prescribed more than one medication. 

Mike Hess: We usually use a combination strategy of these inhaled medications.

Jan Cotton: I manage with all of the prescribed medications by my pulmonologist. A long-acting bronchodilator, rescue inhaler, nebulizer. 

Micaela Arneson: Jan Cotton was diagnosed with COPD in 2000. 

Jan Cotton: The nebulizer for me, I use every six hours. It looks like a pipe. And it keeps me opened up. Once I use that, I can breathe more easy. And it works with the medications that I take. The only thing about it is, after a while, you kind of sort of lose your voice. You may hear a little hoarseness now, and that's why. Because it makes your mouth so dry.

Micaela Arneson: But what if someone is still experiencing flare ups, at least twice a year? Dr. Pirzadeh says there are additional options. 

Dr. Mina Pirzadeh: So there are two medications that we generally use to reduce the number of flare ups. One of them is meant for patients who make sputum and phlegm every day. They take an oral pill every day. The other medication is actually an antibiotic, but we use it for its anti-inflammatory effects. And that's generally taken as a pill three times a week. 

Micaela Arneson: We'll get more into flare ups in a later episode, but for now, here's one last piece of advice from Mike about using whatever medicine you're prescribed.

Mike Hess: Technique is incredibly important with these devices. If you take too little of your medication, you aren't going to get your best effect. And there are some relievers out there that work very similar to adrenaline, so if you take too much of it, you might get kind of jumpy, jittery.

Micaela Arneson: Another important aspect of COPD management and treatment is something called pulmonary rehabilitation. 

Mike Hess: Pulmonary rehabilitation is a structured monitored exercise program. You meet a respiratory therapist, sometimes a registered nurse, several times a week who guides you through exercises, keeping an eye on your oxygen level, heart rate, respiratory rate, so that you are safe and you're taught how to exercise appropriately for your level of breathlessness and other symptoms.

Micaela Arneson: Pulmonary rehab programs also teach people about better nutrition, and importantly, it gives them a social support network.

Jan Cotton: I was afraid, but then I got there and found other people that were in the same condition as me. We became friends. It made you want to keep coming back, not only that, it made you feel better mentally, physically, the whole nine yards. It made you say, I can really do this. You start slow, easy, and you gravitate up until you get where you want to be. 

Micaela Arneson: Another important aspect of a pulmonary rehab program is learning breathing techniques, which are important because people with COPD can easily become winded, even when doing small things. One such technique is called pursed lip breathing. 

Mike Hess: You take a breath in through your nose, you put your lips together like you're about to whistle, and then you blow out through them. That does a couple of things. First of all, it keeps your airways open longer to help flush out some of the stale air. It also gives you a chance to kind of recenter yourself mentally and come back down off some of that anxiety that is always a piece of being short of breath.

Stephanie Williams: The formula is you want to breathe in for two seconds and out for four. Pursed lip breathing isn't something that comes naturally to people. Practice pursed lip breathing when you don't need it and then it becomes like second nature, when you do need it, it's there for you. 

Micaela Arneson: Stephanie also teaches diaphragmatic breathing, which trains people to breathe with their diaphragm, which is that little muscle underneath your ribs, rather than with the muscles in their chest.

Stephanie Williams: It really is difficult for everyone. I mean, really the only people in this world who breathe like they should are newborn babies and opera singers.

When people are living with COPD, their diaphragm becomes flattened and it isn't able to expand and contract like it should. So that's where we ask people to relax, lean back, and put one hand on their chest and one hand just at the base of their ribs. That's where your diaphragm is. When they take a breath in, they want to see that hand that's on their diaphragm rise when they take a breath, when they exhale, we want to see that hand fall back down and return to its normal position. We don't want the hand on the chest to move. 

Micaela Arneson: Give it a try now. Relax and try to lean back, place one hand on your chest and the other below it just beneath your ribs. Now, as you breathe in, try to keep the top hand still and only move the bottom hand up and down by breathing through your diaphragm.

Breathing with your diaphragm feels surprisingly unnatural at first. But practice can help. So pulmonary rehab offers a lot of important tools and techniques to help people manage their COPD and lead a healthy life. But, pulmonary rehab isn't always covered by insurance and not everyone lives near a program.

John Linnell: Sadly, pulmonary rehabilitation is only available for probably 3% of people. 

Micaela Arneson: John Linnell was diagnosed with COPD in 2005, and he's experienced firsthand the differences in access to care across the United States.

John Linnell: Being diagnosed in the Phoenix metropolitan area, and then after many, many years, moving back to rural Wisconsin was certainly an eye opener for me. There's a huge disparity with rural access to health care overall, but specifically for respiratory diseases. We need the same access. 

Micaela Arneson: So if you're someone who wants to take advantage of pulmonary rehab, but like John, you don't live near a program or you can't afford one, don't worry. Dr. Pirzadeh says there are options for you.

Dr. Mina Pirzadeh: If it's a transportation issue with the pandemic, telehealth and telemedicine has really expanded. There are pulmonary rehab programs that actually are video based visits, but for those patients who can't access it for other reasons, online, there is a wealth of resources on breathing techniques and specific exercises.

Micaela Arneson: The COPD Foundation has a list of these techniques on their website. Plus, they run a nationwide program called Harmonicas for Health, which has helped people across the country practice their breathing and strengthen their respiratory muscles.

Stephanie Williams:  The harmonica playing mimics pursed lip breathing. So they're getting the benefits of pursed lip breathing while they're having fun, doing something kind of creative and making music. And honestly, if you can read numbers and arrows up and down, you can play harmonica. 

Micaela Arneson: And if you want to learn more about exercise, what you're taught in pulmonary rehab isn't actually much different from the basic fitness advice all of us should follow.

Dr. Mina Pirzadeh: Part of the focus is on strength training, and the part of it is on aerobic training. So on the aerobic side, it's similar to what people do when they go to exercise at a gym. They're walking or they're biking or doing hand pedaling. And from a strength perspective, a lot of it has to do with upper body strength and using small free weights because the muscles that help you breathe are all in your upper body.

Micaela Arneson: Of course, you should always talk to your qualified healthcare provider about exercise. Like any aspect of your COPD management to make sure you're being safe and using good techniques. Now let's talk about some other resources. As always, visit our website at healthunmuted.com/resources for an updated list of websites, programs, and more.

If you want more information about medications for COPD, check out the COPD foundation, WebMD, and Healthline. And if you're having trouble accessing the medication you need, consider patient or pharmaceutical assistance programs.

John Linnell: I discovered patient assistance programs through pharma companies. 

Micaela Arneson: Many pharmaceutical companies offer their medications to qualifying patients at little or no cost. And there are also local programs in many areas that offer similar assistance.

John Linnell: I went directly to their website, and I said, here's my situation. I have zero income, and I have zero insurance, and I need these meds. Well, I qualified. 

Micaela Arneson: This is the COPD podcast hosted by me, Micaela Arneson. This show is part of the Health Unmuted audio library by Mission Based Media. To listen and learn more, visit healthunmuted.com and follow our show on your favorite podcast player. There are still many questions to answer about COPD, so please do keep listening.