Chronic Obstructive Pulmonary Disease (COPD) | Pulmonary, Critical Care and Sleep Medicine | Department of Internal Medicine | UC Davis Health

Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause blockage of air flowing out of the lungs and breathing-related problems. It includes emphysema and chronic bronchitis. COPD often exists with other medical illnesses. COPD can also overlap with other breathing problems including asthma, heart disease, and sleep apnea.

What causes COPD?

In the United States, tobacco smoke is a key factor in the development and progression of COPD. Exposure to air pollutants in the home and workplace, genetic factors (including Alpha-1 antitrypsin deficiency), and respiratory infections also play a role. In the developing world, indoor air quality is thought to play a larger role than it does in the United States. People should try to avoid inhaling tobacco smoke, vaping, home and workplace air pollutants, and respiratory infections to prevent developing COPD. Early detection of COPD may change its course and progress.

What are the Symptoms of COPD?

• Shortness of breath, especially climbing stairs or inclines
• Cough, especially if chronic
• Phlegm (or sputum or mucus) production on a regular basis

How is COPD Diagnosed?

Breathing tests called pulmonary function tests or spirometry are necessary for the diagnosis to demonstrate an obstruction in airflow (hence the O in COPD)

Where can I learn more about COPD?

copdfoundation.org

At the Comprehensive COPD Clinic, we offer a range of medical treatments for COPD, most include inhaled or oral medications. We assess each patient to identify the optimal medications and delivery device for each patient based on their needs and disease type.

We also offer advanced medications for specific patients when standard medications do not control symptoms or if there are specific indications including:

• Screening for and treating alpha-1 antitrypsin deficiency
• Endobronchial valve lung volume reduction
• Clinical trials screening for new therapies

In 2011, Dr. Sam Louie and a team of respiratory therapists founded the Reversible Obstructive Airway Disease (ROAD) program.

“To see the difference between one-on-one education and classroom-based education, all you have to do is visit a classroom in any of our esteemed universities here in the U.S. and look around at all the people falling asleep,” Dr. Louie explains. “By going to the patient’s bedside and personally engaging with them to provide education in a manner that is palatable and approachable, we are providing patients with enduring value and education that they can be prepared to leave the hospital with.”

The patient education service provided by the ROAD program differs from many other organizations’ programs because it is conducted while the patient is still in the inpatient setting. As soon as patients are admitted to the hospital, they are flagged for enrollment in the ROAD program through provider word-of-mouth or through the use of a screening tool embedded in UC Davis’s electronic health record (EHR).

Following their enrollment in the program, patients are provided with four educational sessions by the ROAD program team members which each last approximately 20 minutes. Beginning on their first day of admission, patients are educated on foundational information about COPD, the medications they will
be prescribed and how to use them, how to recognize impending exacerbations, and what their post discharge care plan will be. By educating patients in this one-on-one, progressive manner, the information is presented in an individualized fashion that has a more lasting impact than the more common classroom approaches to post-discharge patient education utilized by many organizations.

Learn more about the ROAD Center

The ROAD team consists of seven dedicated respiratory therapists. These same respiratory therapists work in the Comprehensive COPD Clinic, often providing continuity of care between inpatient and outpatient settings.

During wildfire season, inhaling smoke can pose significant risks, particularly for individuals with pre-existing lung conditions (such as asthma, COPD/emphysema, and pulmonary fibrosis), heart disease, pregnant women, the elderly, and children. These vulnerable populations should exercise extra caution and consult their healthcare providers for personalized recommendations on precautionary measures. It's important to note that inhaling smoke is detrimental to everyone's health and should be avoided whenever possible.

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Alpha-1 antitrypsin deficiency (sometimes called simply Alpha-1) is a genetic condition passed from parents to children through their genes. Alpha-1 leads to a lack of a protein called alpha-1 antitrypsin (AAT) that is mainly produced in the liver and protects the body, especially the lungs, from unchecked inflammation.  Alpha-1 can result in premature and severe emphysema and liver disease in patients of all ages.

Alpha-1 affects as many as 1 in 2,500 Americans, but remains largely undiagnosed with estimates only 10-20% of actual Alpha-1 patients are aware they have the disease. All patients with COPD should be tested for Alpha-1. The UC Davis is an Alpha-1 Foundation designated Clinical Resource Center, founded by Dr. Carol Cross, Professor Emeritus and leader in Alpha-1 research, and currently directed by Dr. Kuhn. Learn more about Alpha-1 and find out how to receive a free test.

Endobronchial one-way valves occlude airflow in the target lobe to reduce lung volume. Valves are implanted in the target bronchus during a bronchoscopy procedure. The goal is to deflate severely diseased regions of lung to allow relatively healthier lobes and the muscles of breathing, namely the diaphragm, to better function. We work in conjunction with our interventional pulmonologists to identify ideal candidates and place valves in those appropriate.

For patients or providers interested in being considered for endobronchial valves, please schedule a clinic visit in the Comprehensive COPD Clinic and bring pulmonary function tests and a CD with the images of high resolution, non-contrast CT scans (at least 1 mm contiguous cuts at total lung capacity) each from within the past year. Patients need to have completed pulmonary rehabilitation and be on optimal, standard medical care. Six-minute walk and arterial blood gas are also highly encouraged.

Inclusion Criteria:

• Severely symptomatic (CAT >10 and mMRC >1) on optimized medical therapy after completion of pulmonary rehabilitation
• Emphysema confirmed on high resolution (1mm cut) contiguous, non-contrast CT scan
• Severe to very severe obstruction: post- BD FEV1 15-45% (LIBERATE)
• Static hyperinflation: TLC >100% predicted and RV >175% predicted and DLCO >20% predicted

Contraindications:

• Significant bronchiectasis
• Fibrosis
• Pleural disease
• Giant bullae (>30% hemithorax)
• Active tobacco use
• Active lung infection (e.g. Mycobacterium avium)
• Nickel or titanium or silicone allergy
• Failure to complete 6-minute walk distance (6MWD) between 100m and 500m following a supervised pulmonary rehabilitation program

Endobronchial Valve Lung Volume Reduction (PDF)

Our team includes several NIH-funded investigators focused on basic and translational ILD research.

At the Comprehensive COPD Clinic we believe clinical and basic research is a vital part of caring for COPD patients. By enrolling COPD patients in clinical studies, we may learn important and potentially life-altering ways to treat COPD. We currently seek to enroll all subjects on a voluntary basis into our COPD Registry upon the first visit. In addition, we screen patients for potential participation in ongoing studies at UC Davis. Learn more about available studies below:

• UC Davis Health Pulmonary Clinical Studies
• UC Davis Center for Comparative Respiratory Biology and Medicine