The Invisible Epidemic of COPD
[Music]
invisible
epidemic that’s an unusual combination
of words
epidemic we all know i mean we’ve lived
through the last year
where we’ve heard it almost every day on
television
or some news media outlet but to have
the word invisible
juxtaposed gosh that seems odd
because usually by the time something
reaches epidemic proportion
we all know about it how could we have
an epidemic
at our doorstep and you not know
you’re probably thinking i bet she’s
going to talk about the next ebola virus
or maybe the next coronavirus it’s not
either of those
in fact four letters represent this
disease
it’s c o p
d chronic obstructive
pulmonary disease it’s a lung disease
that accelerates as you age it makes it
difficult
for you to breathe and it alters your
ability to do
daily activity okay i’m seeing you
you’re looking confused you’re thinking
how could it be this big and i’ve never
heard about it
don’t feel bad i’m a doctor and i hadn’t
even heard that much about it so let me
take you back about 10 years on my own
journey
we were working with a group of
physicians and scientists and we had
some national funding and we were
looking at large data sets
and we wondered if we looked at this
electronic medical record
could we find patients that might not
know they have a disease today or if
they have one today
if we intervened if we got to them
sooner
they might either get a cure or a better
outcome or at least a better quality of
life
i was excited i thought this sounded
like noble work
in fact i was already thinking cardiac
disease
that’s the number one killer in america
followed by cancer we’ll probably work
on those two
and i was knee-deep in my discovery
when a colleague tapped me on the
shoulder and got my attention
she said gene have you thought about
working on
copd i looked at her and i said
copd isn’t that the lung disease that
smokers get
i mean and if you have the disease
wouldn’t you already
know it how could work like mine help a
problem like that
she said first gene you’re wrong on both
counts
it’s not just a smoker’s disease and
millions
of people have the disease and don’t
know they have it
wow over the next few weeks and months i
began to learn from a variety of sources
my friend was right 30
million americans have copd
30 million to put that to scale that’s
like the population of north carolina
south carolina and georgia it’s actually
the
near population of all of canada it’s a
big
number wow but you know what’s more
interesting than the big number
is if you take that 30 million and
divide them in half
half of them have already been diagnosed
they’re seeing their doctor hopefully
they’re on the latest
medication regimen perhaps they’ve been
enrolled in virtual or
in-person pulmonary rehab they’re in a
support group and they’re optimizing
their outcomes
that’s what we would hope for those 15
million but there’s another 15 million
that look for all the world like them
but they’ve never been diagnosed
who are they and and how did we miss
that many people i think there’s several
reasons
why we’ve missed that many people one
reason is
this disease often imitates or mass
by other diseases so if you had a heart
attack two years ago and you’re a little
short of breath today
it’s easy to think i wonder if that
heart attack is keeping me from climbing
that flight of stairs
maybe it’s the arthritis kicking in and
you’re thinking i just can’t get around
like i used to
or just the fact of aging and you’re
thinking you know i’d really love two
kids
but i can’t keep up with the grandkids
anymore so i won’t be joining you
to disney world so underneath all those
things
while those may be present you could
still have
copd wow
now as a researcher you had me intrigued
so i started to do my own
discovery work and i started with the
most obvious factor
smoking well just like i thought
a lot of people who smoked ended up with
this disease
in fact of all the people with copd 75
percent of them have smoked
but that means 25 percent have the
disease
but they’ve never smoked well what’s
with those people
how did they get it i was even more
intrigued
so i thought let me start with some
graphs and some charts
so i rolled out a map electronically of
the united states and
we data analysts can populate it in a
variety of ways and i said show me
so to speak all the patients with copd
and i thought if smoking’s a factor i
bet there’s not much in utah
ghost a figure and there wasn’t but
there’s not even much in california
and there’s not but when i looked at the
rest of the united states it was not
evenly distributed in fact as i looked
along the appalachian mountain range
there was this deep density okay i saw
where your mind went
you’re thinking gene that’s tobacco road
that’s where tobacco has been
raised and farmed and packaged and sold
for years
well data scientists can pull out that
factor in fact
i removed the impact of smoking i even
one step ahead of you removed the impact
of exposure to coal dust
and it was still there it was still more
prevalent
than anyplace else in the united states
west virginia virginia
tennessee kentucky north carolina
now it’s getting personal because see
those are my people that’s where my
mom’s family’s from
and i’m thinking wow are we at a higher
risk for copd
so i thought it must be the genetics so
like a good scientist like pasteur i
went and tested myself
spitting the tube a few weeks later the
answer came back
lo and behold i tested as a person
deficient in an enzyme called alpha one
anti-trypsin alpha-1 is the disease
that’s most
recognized as the most prevalent form
of genetic copd
and there it was in my genes now
gratefully i’m a carrier and i don’t
have symptoms of it
but it made me think of so many people
in my family
people who i thought got short of breath
had frequent bronchitis
pneumonia lung disease maybe even use
oxygen so i started calling around the
family
and we started sharing notes back and
forth i also learned that it wasn’t just
my mom’s
family that was at risk see my dad’s
family had come from scotland
i’m a first generation immigrant and
a lot of people who immigrated from
scotland in england
and ireland besides bringing along
fiery redhead to women men who wore
kilts
a taste for fine whiskey they also
brought
copd wow who knew
i was at risk from both sides of the
family
so smoking location in fact just living
in a rural community
you have twice the rate of copd
than living any place else in the
country maybe it’s your genetics
maybe it’s poor air quality
pollution smoke fire
perhaps you work in a foundry perhaps
you work on a farm perhaps you’re in a
paint plant
all those things that you inhale impacts
your lungs over time
and it takes its toll wow
you know i think about 9 11 i think
about the brave
men and women who were the first
responders who ran into those
flaming towers if they were so fortunate
as to be able to leave the building
alive
i assure you they left with copd
even this year with the fires on the
west coast
in california in oregon not only are the
first responders
at risk so were the people whose homes
were affected
the people whose cities were covered
with smoke
by the year 2050 poor air quality
will be the leading cause of copd
around the world in fact 300
million people around the world have
copd
so it’s not just an america problem it’s
a global problem
now in 2050 when we refer to it as poor
air quality
smoking will still be there it will
still be a cause
it just won’t be the cause
it will be one of the causes
so genetics poor air quality
childhood asthma childhood asthma is the
leading chronic condition
of children it’s not surprising to me as
a doctor
that the asthma that seems so innocent
at first is also the asthma that can
scar
and cause the lung to remold making it a
set up for altered patterns
of breathing later in adulthood we also
know that
vaping and e-cigarettes are going to
create
lung conditions that we have not seen
before
and last but equally as important is
covet
covets a pulmonary disease it’s a lung
disease
we are in the early stages of learning
what it’s like
to have a postcovid world and will that
accelerate copd
in so many people so there’s lots of
reasons
somebody could have copd now as a doctor
i always try to picture what does that
person look like
with copd’s or any disease for that
matter but for copd
first of all i think of the person with
a chronic cough
a lady sat behind me in church one week
and she was coughing frequently
and this is long before covet and she
leaned over and she didn’t know who i
was and she tapped me on the shoulder
and she said don’t worry i’m not
contagious i have copd
so is that person with a chronic cough
frequent bronchitis needing antibiotics
having emphysema may actually require
oxygen
limited steps you probably have seen
them
but maybe never really stopped to think
about them
my generation of women we were
encouraged to smoke we were told we had
come a long way baby
and we did not only did we come a long
way in smoking
we also came a long way in copd because
not only do we get the disease we get it
earlier in life and we get it with a
heavier
burden of symptoms so we’re hit
on two counts
what do we do when we see something like
this well i mentioned i try to
personalize it
let me give you a peek into somebody in
my family that i think
represents this she’s female she’s older
in fact she’s aunt bernice see and
bernice lived all
her life in the appalachian mountains in
the foothills of the smokies to be
exact she worked in a factory she
upholstered
chairs she was always fit as far as i
knew i never knew her overweight
and i never knew her to smoke when the
other ladies at the plant
would take a lunch break or smoke break
aunt bernice would go for a walk and so
even up into her 80s
she would be walking four or five miles
a day
so when she finally retired she called
me one night
and as one of the doctors in the family
it’s not unusual for us to get a call
from a family member asking us to
explain something medical
so she said jane anne jean anne this
is your aunt bernice and i knew
for her to call something must be up and
i said well well what’s up
and she said something ain’t right i
can’t walk to the mailbox okay
she’s 80 years old and been walking four
to five miles a day
and she notices change in daily activity
is significant for her well i had been
thinking about copd
i thought about our family genetics i
thought about how she lived in
appalachia
i’ll write her doctor and i’ll get her
doctor to check
her lung health so i wrote him and a few
weeks later
i got back a letter dear dr wright
i have examined your aunt bernice i have
good news
she doesn’t have copd
i was relieved but then he went on to
say
because she never smoked
period ended the workup
see because she never smoked he never
stopped to think about
she had worked in a factory she’d been
around smokers her husband had been a
lifetime smoker
alpha won anti-trips and runs in our
family and she lives in a rural zip code
i think he missed it now we are blessed
with the genes for longevity for the
women in our family and she lived a long
life
but i would tell you the last 10 years
of life she did not live an active life
because she no longer could do the
things that were important to her
you know visiting her friends going to
the church covered supper
going to the buffet at the mall because
she didn’t quite
have the energy and stamina for that
all right when we figure out that
there’s an epidemic here in the united
states
what do we do about it it’s the american
spirit we double down right the
scientists go to work
they start looking for the cause they
look for cures industry starts cranking
out new
vaccines we see that currently right now
going on
all around us the word gets to
clinicians and doctors begin to talk to
patients
and they begin to ask them could you
have the symptoms
of whatever the new disease is
so let me ask you for a second think
about your last time at the doctor’s
office did she
or he ask you about your lung health
i probably know the answer it’s probably
no they might have asked you did you
ever smoke and you checked the box one
way or the other
but did they ask you about your lung
health you know lord knows they do a
myriad of tests
your blood pressure an ekg a hemoglobin
a1c
why don’t they do a test for your lungs
well you’re wondering it must not exist
or it’s too expensive
i wish that were the case but that’s not
true almost every doctor’s office
has access to spirometry
it’s a simple straightforward test they
hook you up to a machine
you breathe in and out and they measure
the volume of air that goes in and out
and they measure how quickly the air
goes in and out
within a few minutes you can have a
diagnosis
but you can only get that test at a
doctor’s office a hospital a pulmonary
rehab lab
what if you could get to it without a
doctor’s prescription what would be the
harm in that
you know the other day i was at a
grocery store chain
and i had gone up to the pharmacy to get
my annual flu shot
so while i had one arm all
pushed up for the flu shot i looked and
saw the blood pressure machine
over there and i thought maybe after all
this
i’ll go get my blood pressure checked
now i have one of those machines at home
and i do it frequently but i thought it
won’t hurt just
just to check what if next to that blood
pressure machine
there had been a way to do spirometry
what if i didn’t have to go through the
doctor’s office cue to do it
maybe just screen me to see do i need
more of a workup i’ll tell you here’s a
quick and easy work around
the next birthday party that you’re at
carefully remove one of the birthday
candles
and hold it at arm’s length
if you can blow it out at arm’s length
your lungs are probably in pretty good
shape
but if you can’t that should be a
warning sign to you
to have this conversation with your
doctor
so we usually do all these things when
we have epidemics we also have advocacy
campaigns you know just just right
driving here today i saw several
billboards
i saw one about hepatitis c i saw one
about the flu vaccine
i even saw one about getting a
colonoscopy it was pretty cute it said
there’s no buts about it and it had some
humor written into it
where was the billboard about copd
in fact where have i ever seen a
billboard about copd
i haven’t in fact where
are the famous faces of copd
actors actresses politicians athletes
uh you got me there too i can’t think of
one now i’m old enough as a doctor that
i remember the early days of hiv
and aids and i knew how critical
it was to creating knowledge across the
country
for brave men and women to step forward
and say
either i’m hiv positive or i have aids
or later on
i have mental health or somebody in my
family has alzheimer’s
it’s those powerful voices of influence
that can alert a community in ways that
nobody else can
but we don’t have those we also know
that we need
more research right from research comes
new drugs new cures new treatments copd
is the third leading cause of death it’s
heart disease
cancer copd number three
but it’s 165th
in terms of nih funding third most
common disease
third most lethal disease 165th
in funding now i’m not blaming the nih
they’re doing a great job and they’re
trying to get the word out but the nih
can only do what congress mandates them
to do what congress gives them the
budget to do
and congress is moved by voices like
yours and mine that cause them to pay
attention to a problem
to vote in new legislation and to
redirect funding
and it simply hasn’t happened
there has not been a new drug
new category of drug for this illness in
11
years that’s a long time to have your
finger
on the pause button i can tell you we
would not tolerate that
for cancer or heart disease or
prematurity or any other
kind of disease but 11 years to be
waiting
on the next drug is way too long
so what if you and i partnered
and we decided we were going to do
something different
we were going to start a movement so
that we could find
the missing millions you know that
we can do this it’s really
that simple because now you’re armed
with some new information
and there’s lots of places you can go
online to learn additional facts
i would encourage you to start with
yourself
ask yourself am i at risk for copd
start a conversation with your doctor
and say could you please check my lung
health
and see if i need spirometry or other
some other form of
measurement of my lung capacity have an
intergenerational conversation this fall
with your family
talk to them grandma grandpa mom and dad
aunt and uncle
tell them what you’ve learned about copd
you know i’m a analytic geek at heart
and there’s an amazing thing that
happens
in the spread of numbers if i can get
two of you today to take this message to
heart
and go tell two more people and they
take it to heart and they tell two more
people
and they take it in 32 cycles
we will have reached 7 billion
people the entire population of the
globe
now i am aspirational but not that much
frankly i would be happy
if we could reach those 15 million
americans
who have the disease and don’t know it
it starts with you it starts with your
health
it starts with your conversations and
together
we can make the invisible
visible
thank you
[Applause]
for those 15 million