UC Davis Comprehensive Chronic Obstructive Pulmonary Disease (COPD) Clinic
Who We Are
COPD will be the 3rd leading cause of death in the United States. More women have died annually from COPD than men since 2000. The UC Davis COPD/Pulmonary Rehabilitation Program was established in 1993 to improve the quality of life of COPD patients through patient education, treatment recommendations in a COPD action plan, exercise, and emotional support. The UC Davis Health System offers a multidisciplinary team of dedicated healthcare experts who will individualize a physical and emotional reconditioning program to control and reduce breathing difficulties from COPD as well as asthma and bronchiectasis to prevent acute exacerbations and hospitalizations.
The Comprehensive COPD Clinic exists to provide excellent care to people living with COPD. As COPD can be a complex and debilitating disease, we view each patient in a holistic way. We strive to provide optimal medical care, access to cutting-edge therapies and procedures, and exposure to clinical research studies all aimed at improving a COPD patient’s quality of life. The Clinic is headed by Drs. Schivo and Kuhn in partnership with respiratory therapists, nursing staff, and clinical research coordinators who interact with each patient. The Clinic sees over 200 COPD patients annually. We are tightly connected with other lung specialists and other physicians within UC Davis since COPD patients often have multiple medical needs.
- Associate Professor of Medicine
- Co-Director, Comprehensive COPD Clinic
- Assistant Professor of Medicine
- Co-Director, Comprehensive COPD Clinic
- Director, Alpha-1 Antitrypsin Deficiency Clinic
- Professor Emeritus of Medicine
Reversible Obstructive Airway Disease (ROAD) Respiratory Therapists
- Krystal Craddock, R.R.T.
- Marcy Dolan, R.R.T.
- Jimmy Nguyen, R.R.T.
- Michael Dirks, R.R.T.
- Alexandra Ellis, R.R.T.
- Justin Griffiths, R.R.T.
- Fatema Bassia, R.R.T.
Pulmonary Clinical Research Coordinators
- Maya Juarez, C.R.C.
- Tina Tham, C.R.C.
- Daniel Tompkins, C.R.C.
- Karla Ramirez, C.R.C.
Our Unique Approach
The first step in our clinic is confirming the diagnosis of COPD, as there are numerous diseases that can mimic the classic symptoms (i.e., bronchiectasis, vocal cord dysfunction, asthma.). COPD is often diagnosed prematurely and incorrectly, especially in any active or former smoker with respiratory symptoms.
After diagnosis is confirmed, we thoroughly characterize an individual’s COPD phenotype and screen for known concomitant and likely contributing diseases (coronary ischemia, heart failure, pulmonary hypertension, asthma, bronchiectasis, interstitial lung disease, sleep apnea, and alpha-1 antitrypsin deficiency).
Respiratory therapists who specialize in COPD from our ROAD program work alongside the physicians to optimize mucous clearance, inhaler device selection and proper use, non-invasive mechanical ventilation, and supplemental oxygen delivery.
Because COPD comes in many phenotypes, treatment is tailored to individual patients and their burden of disease. Treatment includes optimization of standard therapy as above, as well as more advanced therapies such as endobronchial valve lung volume reduction, alpha-1 augmentation therapy, and consideration for interventional clinical studies.
Our Comprehensive COPD Clinic Treats:
- Chronic bronchitis
- Alpha-1 antitrypsin deficiency
- Asthma/COPD overlap
Other airway diseases
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?
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.
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.
- 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
- Significant bronchiectasis
- 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
Learn more about Endobronchial Valve Lung Volume Reduction.
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:
Appointments & Referrals
UC Davis J Street Center for Respiratory Health
2825 J St., Suite 400
Sacramento, CA 95816
Clinic Fax Referrals
How to Refer to our Clinic:
General information, questions
and help choosing a UC Davis doctor:
800-2-UCDAVIS or 800-282-3284
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800-4-UCDAVIS or 800-482-3284
24-hour hospital operator