Subscribe
Share
Share
Embed
"From Lab to Life" is a cutting-edge podcast that bridges the gap between groundbreaking medical research and real-world clinical practice. Hosted by leading experts in the healthcare field, each episode delves into the latest innovations in medicine, offering insights on how scientific discoveries translate into practical solutions for patient care. From emerging therapies to case-based discussions, this podcast equips healthcare professionals with the knowledge they need to bring the future of medicine into their daily practice. Join us as we explore the journey from the lab to life.
Dr. Stephanie Christensen (00:03.99)
I'm Dr. Stephanie Christensen, Associate Professor of Medicine at the University of California, San Francisco. Welcome to Leveling Up COPD Care, Closing Critical Gaps in Vaccination Guideline Adoption, Improving Clinical Inertia, and Integrating Personalized Approaches to Care. I am joined today by my esteemed colleague, Dr. Robert or Bobby Burks.
who is an assistant professor of pulmonary critical care and sleep medicine at the University of Cincinnati College of Medicine at the University of Cincinnati. For financial disclosure information, please see Iridium's landing page for this activity. This educational activity is supported by an independent educational grant from GlaxoSmithKline. And we would like to thank them for their support and initiative.
So the learning objective for today's program is to identify the critical role of vaccinations, including those for influenza, coronavirus, pertussis, pneumococcal, and zoster as recommended by Gold in preventing exacerbations and complications associated with acquired infections. Dr. Burkes, I was hoping you could start off our conversation today.
by telling us a little bit about what clinicians need to know about COPD, its impact on patients, and a little bit about the prevalence. Certainly. So I think to start, it's probably worthwhile to define chronic obstructive pulmonary disease. COPD is very heterogeneous. It's probably more of a catch-all term for an umbrella of shared exposure profiles, symptomatology's, and outcomes that we label as COPD.
Lifetime exposure is usually combustible tobacco smoke leads to a loss of airways integrity leads to a loss of populated airways use can cause chronic bronchitis. And all of this together causes progressive airflow limitation. They can get air in, can get it out. There are key COPD risk factors that there be aware of on the mainland United States. The overwhelming majority of people will have exposure, personal exposure to combustible tobacco cigarettes. However,
Dr. Burkes(02:14.103)
There are other risk factors of developing COPD. Among them are, of course, particular matters, whether that be environmental air pollution or in certain areas, home practices such as using wood and biomass burning stoves without good enough ventilation. Certainly abnormal lung development. Did your lungs not develop to maximum capacity? Accelerated lung aging in the response to all of these environmental exposures.
do you more rapidly lose lung function? And then kind of the big genetic factor that we know of is alpha-1-H trypsin deficiency, which leads to COPD classically in younger people. That is really the most prevalent and treatable genetic condition leading to chronic obstructive pulmonary disease. So chronic obstructive pulmonary disease is very common. Around 14 million adults suffer with it in the United States.
roughly one in eight people older than 65 years old. And the prevalence, despite tobacco smoking decreasing, has remained basically the same since 2011. So it's a condition that's still with us, it's a condition that still affects folks in the United States and worldwide. It's seen in people who either currently smoke or have smoked in the past. And the population tends to be older with certain caveats. It's also very costly for the United States healthcare system, more than
$30 billion. What generally drives that cost in chronic stroke and pulmonary disease is the care that's required to address exacerbations when they arise. The bulk of exacerbations are caused by an infection and primarily by viral infection. Certainly, they can be caused by bacteria, they can be caused by environmental exposures, but viruses remain the cause that's probably the most common.
and certainly most addressable. So two things really happened here. One, because folks with chronic obstructive pulmonary disease don't necessarily have the defense mechanisms. When somebody with CRPD has a virus, not only do they have the impaired host defenses, not only are they potentially more likely to respond in a more exuberantly inflammatory manner than somebody without chronic obstructive pulmonary disease, they also do not
Dr. Burkes (04:36.653)
the inflammation that comes with the immune system's response to a virus as well as somebody with normal caliber airways who haven't lost lung function. And it leads to a very chronic cycle where one exacerbation leads to damage and that in and of itself begets another exacerbation. The virus's ability to upset the activity of both innate and to a certain extent adaptive immunity and kind of the
cells that's in between those two, they can lead to more issues with bacterial infections either during an acute exacerbation of COPD or longitudinally over time. Either way, both cycles, whether it's just a virus, whether it's kind of an intermixing of how viruses and bacteria interact together in the lungs, this process leads to a loss of lung function.
deteriorating quality of life and as stated, unfortunately, probably promotes future exacerbations of CRPD. Viruses do a fantastic job of driving immune processes that are somewhat maladaptive, right? And because of that, what you see is that if you were to look at a subset of patients hospitalized with pneumonia,
the most common comorbidity you would see is that they also have a diagnosis of COPD. The fact of the matter is that would probably be similar across all lung diseases, but COPD is so common, then the hospitalized population at large, that COPD is associated very strongly with also having pneumonia, especially in an older population. That's really helpful, Bobby, to kind of really understand, you know, that interplay between COPD and pneumonia. I think we talk about COPD and other
kind of acute diseases and also chronic diseases. But I think the next question is really around vaccines. We're really in a time when we have a lot of vaccines. So maybe have a lot of preventative measures for at least the virus portion of infections and pneumonias. Can you comment on...
Dr. Burkes (06:55.595)
the available vaccines and what are the guidelines for administration, particularly in COPD? There are international guidelines to vaccine approaches in chronic certain pulmonary disease. Classically, you have your very common vaccines like the flu, right? It should be given annually with consideration to the stronger dose among people greater than 65 years old. COVID, they should be given on whatever the most recent recommended schedule is from authorities.
Pneumococcal vaccinations are very important in this population. And while there are timing schedules of pneumococcal vaccinations, it's differential depending on which vaccine is given first. And what I've found in my experience is that you just end up going with whatever's available in clinic. If you were to look at the efficacy of one vaccine schedule over another, sure, you will absolutely find differences.
but probably in our patient population, those differences are so much on the margins that it is better for a patient to have a pneumococcal vaccine that's available on a schedule that's data-driven rather than deny them pneumococcal vaccination while you try to find them, you know, the most ideal one. Then obviously with the emergence of the respiratory syncytial virus vaccine, that's also recommended in patients with chronic stroke and pulmonary disease as is Tdap.
especially if the person has never been vaccinated with that agent, and then the zoster vaccine on the recommended schedule. But all of those vaccines are warranted and reasonable to use in a patient with COPD. One last piece is that vaccination can seem somewhat overwhelming. One, there's no reason to get too fancy. You just follow the schedules and follow the recommendations. And the other thing is that in COPD,
Prevention is so important that this should be seen as a necessary part of the preventative package that we provide the patients with COPD, you know, along with their inhalers and their smoking cessation and means to prevent their disease from either rapidly progressing or for them to have frequent exacerbations, which tend to lead to even more poor outcomes. So we know that there's actually still low rates of vaccination.
Dr. Burkes (09:21.325)
despite the guidelines. And can you tell us a little bit about vaccination rates and, you know, maybe eventually kind of talking about what we can do to overcome some low rates of vaccination? The ratio of patients with COPD who received flu in the last year is around 53%, 63 % for pneumococcal. And it really, there's kind of a 30,000 foot view bigger picture of why this is an issue.
And then there's going to be a patient to patient reason. What tends to happen, I think, is if you look at the well-conducted longitudinal studies in COPD, and there are many at this point, quite frankly, if you pick an underserved population, COPD will be more prevalent in that population than people who have ready access to healthcare.
is the poor vaccine uptake a function of a system where it's very difficult for people to access healthcare on a schedule, be seen for follow-up, know, even physically get to where their physician is because of transportation issues. I'm sure that plays a very, very big role in why there's a large amount of concern around vaccine uptake. I would argue that it's probably the biggest contributor.
And then from person to person, mean, I with CPD, it's a longitudinal disease. These are folks you see years on years on years. And as you get to learn people and learn what they're about, learn what's important to them and what their concerns are, generally through that physician-patient relationship, you can find a way to answer their questions and see if maybe vaccination is more appealing to them.
A lot of people want to be very participative in their care and are just unaware that these things exist and may help them. Accepting the patient's concerns, if their concern can be addressed, address it, that becomes very patient to patient. I've spent some time pulling up, you know, papers on the RSV vaccination and showing them the table that had all the side effects and the percentage and said, you know, you have a one.
Dr. Burkes (11:42.973)
a 0.85 % of X happening. Is that something you'd be willing to tolerate? And you know, sometimes they respond to that. Other times, it's just like a very general, like these are potential side effects. They're rare, but they could happen, you know, and this is the benefit that you would get. And then the big one for me is access. There are a lot of people who come in that just don't have great access to healthcare. And if they do find their way into your office,
while they're a captive audience, again, people wanna be participative in their health, they just don't always have the means to try to be as informative as you can and help them as much as you can. And potentially, if they're interested in vaccinations, vaccinating them then, kind of goes back to what I said about the pneumococcal vaccination, where yes, there's differences between strategies on the margins, but like if somebody's there and they're interested in being vaccinated and they think it's going to help them,
and you think it's going to help them and it's on guidelines, you may as well just do it because that marginal difference is just not worth it. And then activation of a plan, just that you have a plan to get a person a vaccine, even if it's just a list of places that provide the flu vaccine, local pharmacies, other clinics, things of that nature. Basically understanding why there's hesitance to receive a vaccine.
And seeing if there was anything you can do to swage their fingers, answer their questions, make them feel more comfortable and really make them feel like, and they are, but make them feel like they're making a decision that's going to benefit their health over a long period of time. The other thing I found, especially it's been very prevalent with RSV and to a certain extent COVID, explaining what these things actually are. mean, COVID got a lot of press, RSV kind of came in passing.
And it doesn't need to be, you're not taking a test. You're not taking your board exam. My approach is that like RSV is very much like the flu, but it's not caused by the same virus. You've probably had RSV before and thought you had the flu, right? And I think that, you know, just so it's, it's clear and it's understandable and the person feels well informed and they know what they're being protected against.
Dr. Stephanie Christensen (14:07.103)
Yeah, I think that's a really great approach. So thanks for sharing. It's always actually really great to learn from other clinicians, their approaches, because I think there's always a little nuance there. So I'm just going to summarize what we've been discussing today. So first, that COPD is a very heterogeneous disease. It affects millions of people in the US and worldwide. It can be triggered or exacerbated by
and those include viruses and bacteria. It can also be exacerbated by pollutants and certainly tobacco smoke exposure, as you said, is a major cause, but not necessarily the only cause. As far as vaccines, challenges such as low vaccine rates, vaccine hesitancy may both contribute to infection cycles. So,
and increased exacerbations, increased symptoms, and that can actually lead to progressive loss of lung function and deteriorated quality of life. So it's really important that we are thinking about these things. We've reached the end of this episode. I wanted to thank Dr. Burkes for this engaging discussion. We would also like to thank GSK for their support of the program. Be sure to claim your CME credit by filling out the evaluation and post-test.
This is one of a four part series, so be sure to follow Iridium on socials to see the corresponding remaining episodes and Med-Ed threads.