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  • Writer's pictureRichard Lai

#65 - Biomedicine Board Review: Chronic Obstructive Pulmonary Disorder

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Transcript of Episode

Dr. Richard Lai DPT LAc [00:00:00]:

Hey. Let's talk about COPD. Come with me. Hey, everyone. Doctor Richard Lai here with study acupuncture with me. Now I welcome you back to the channel. Let's continue on this month with biomedicine board exam preparation. Now today's topic is Chronic obstructive pulmonary disorder.

Dr. Richard Lai DPT LAc [00:00:22]:

So what is COPD? COPD is a categorical name for a group of obstructive pulmonary disorders, which if you break down the word itself, it's a category of pulmonary disorders, meaning disorders that affect our respiratory system. And these pulmonary disorders are obstructive in nature. That's the keyword, obstructive. And so why are we paying so much attention to that word obstructive? And the reason we're paying so much attention to that word obstructive It's because of one of the principles of yin and yang, which applies to all facets of our life. So for example, there's day because there's night. Likewise, there's obstructive disorders because there's also restrictive disorders. And in this episode, we're gonna talk about chronic obstructive pulmonary disorders, which in general is an obstructive type of respiratory issue. Now it includes diseases like emphysema and things like chronic bronchitis.

Dr. Richard Lai DPT LAc [00:01:23]:

Now these types of respiratory issues are obstructive, meaning the patient's gonna have a hard time Exhaling all of the air that's in their lungs. That's the word obstructive. It's related to, like, the word obstruction. Obstruction means a blockage. It means an obstacle. It means something that prevents or it impedes passage through. So with this type of patient, again, they're gonna have a hard time exhaling all of the air in their lungs. On the other hand, with restrictive lung diseases, These patients have a hard time filling their lungs with air, which the most common restrictive lung disease is idiopathic pulmonary fibrosis, which Idiopathic pulmonary fibrosis is a disease that causes a scarring of the lungs.

Dr. Richard Lai DPT LAc [00:02:09]:

That's what fibrosis means. Fibrosis means a thickening or a scarring of tissue. Now why does idiopathic pulmonary fibrosis happen? Well, the answer to that is that we're not really sure. That's what idiopathic means. Idiopathic means unknown cause. Now we know that there's some things that are linked to fibrosis. So things like viral infection or smoking For long term exposure to dust, especially things like metal dust or wood dust, so that's, for example, people who work construction jobs, And long term effects of inhaling or just being around all that metal dust or that wood dust while they're working on building skyscrapers and houses, That could be linked to pulmonary fibrosis in the long run. So, again, with restrictive lung diseases, the patient has a hard time filling their lungs with air because the lung tissue is so scarred up.

Dr. Richard Lai DPT LAc [00:03:03]:

So expanding the lungs is really difficult. Now with COPD, COPD includes diseases like asthma, emphysema, and chronic bronchitis. Now these are all diseases that are obstructive in nature. For example, with emphysema. Emphysema is a type of chronic obstructive pulmonary disorder. Now with emphysema, there's damage to the alveoli of the lung. The alveoli are basically these tiny air sacs in the lung where gas is exchanged. Basically, when we inhale, this alveoli expands like a balloon so that the body can absorb The oxygen that our lungs inhale.

Dr. Richard Lai DPT LAc [00:03:41]:

And where does that oxygen go? It goes into our blood. Remember we talked about in the previous episode about How blood goes into the lungs and it gets oxygenated there. So the absorption of oxygen turns the blood that goes into the lungs into rich Oxygenated blood, and then it goes back into the left atrium, left ventricle to be pumped out to the body. But with emphysema, Things like smoking, things like exposure to pollution, that can cause long term inflammation to the alveoli. That can cause the alveoli to scar, and it's gonna lose its elasticity. So if it loses its elasticity, then it's not gonna expand well, which in turn is gonna make exhaling Really difficult and tiresome for the patient, and the lungs can actually become permanently enlarged as a result. So when you look at the patient's form, Their chest is gonna look like a barrel, which is actually termed barrel chest. So now what are the typical signs and symptoms that we would see in a patient with COPD.

Dr. Richard Lai DPT LAc [00:04:39]:

The typical symptoms are, number 1, chronic cough, number 2, expectoration, and then number 3, exertional dyspnea. Now dyspnea, it just means shortness of breath. It's basically the sensation or this feeling like you can't get enough air. Now the intensity of these symptoms, they're gonna vary from patient to patient. But in general, for all cases, the onset of it is slow. And As the disease progresses, the dyspnea is actually gonna happen at progressively lower and lower activity levels, which everything we do requires different amounts of energy from us. Climbing upstairs requires more energy than just standing up from a stool. Now with COPD, At one point, you'd be able to walk up the stairs that you need to get into the house and be just fine.

Dr. Richard Lai DPT LAc [00:05:26]:

But as the disease progresses, Climbing those same stairs are gonna feel like you climbed 2 flights of stairs. And after you climb those 4 steps, you need to sit down and rest for a really long time. And as the disease progresses more and more, the dyspnea is gonna happen at lower and lower activity levels. So even something simple like Standing up from a chair can be really tiresome. Even something as simple as rolling over in bed can actually make you feel extremely short of breath. And for me, I've worked with patients who were late stage COPD, like, gold stage 4. Literally, the only thing that they could do was lay in bed. The tiniest little bit of movement, it felt like they used up all of their air.

Dr. Richard Lai DPT LAc [00:06:07]:

I had this 1 patient. She's a lovely lady. I treated her in a nursing home. You could tell she was a really sweet person, but medically, she was extremely compromised, gold stage 3, 4. She was cognizant of everything too. And she told me every treatment, she just told me. Just leave me alone. Give up on me.

Dr. Richard Lai DPT LAc [00:06:25]:

I just wanna die. And she was asking the doctor to put her on hospice, but I didn't give up on her. After weeks weeks weeks of therapy, just starting off first with small movements, I had her bend her elbow. I had her straighten her elbow. That was it. And then we would progress it up to do it 3 times. Bend your elbow. Straighten your elbow.

Dr. Richard Lai DPT LAc [00:06:44]:

The next day, we would up the ante a little bit. The next day, we would up the ante a little bit more. And I would tell her all the time, I'm not gonna give up on you, so you don't give up on me. So now let's bend your knee. Let's straighten your knee. Let's breathe. Let's expand your chest. Let's exercise those breathing muscles.

Dr. Richard Lai DPT LAc [00:07:01]:

And the biggest hurdle was, like, today, let's try sitting up at the edge of the bed just once. And then slowly but surely, little by little over time, we got her to the edge of the bed. We got her to stand. We got her to get into her wheelchair. Now this is someone who, when I first met them, just turning their head or letting me reposition the pillow under their head, that took out all of their energy. So fast forward from that to the end of care. She was walking short distances from the bed to the bathroom. She was participating in all these activities in the nursing home.

Dr. Richard Lai DPT LAc [00:07:34]:

She actually even became the editor of the monthly newsletter in the nursing home. So it just goes to show you what a little bit can do over a long enough time horizon. Now the last thing we'll talk about is what a gold stage is. I mentioned my patient before. She was gold stage 3 or 4. So now what does that mean? Basically, for COPD, there is a severity scale. That severity scale is called the GOLD classification system. Gold stands for global initiative of chronic obstructive lung disease.

Dr. Richard Lai DPT LAc [00:08:03]:

Now this scale, it goes from 0 to 4. 4 is the most severe. 0 is someone who's at risk. Now this scale is based on these abbreviations, FEV one and FVC, which you can get these numbers through a pulmonary function test. FEV one stands for forced expiratory volume, And forced expiratory volume is how much air you can force out of your lungs in one second. That's what the one stands for. FVC, that stands for forced vital capacity. Now this one is regardless of time.

Dr. Richard Lai DPT LAc [00:08:36]:

This is just the max amount of air that you can breathe out after you breathe all the way in as much as you can. And so there's a ratio or a percentage that you can get from these 2 metrics, which with an obstructive type pulmonary disorder, you'd have a low one second forced expiratory volume to forced vital capacity ratio, which that's defined as less than 70% in adults. So I'll show you this table here. And on this table, you can see 70% all the way down. That's a low one second forced x-ray volume or FEV one to forced vital capacity, FVC ratio. Now if it's an obstructive type, that means that you would get less than 70%. So that's why you can see on this table, less than 70% ratio all the way down. And doctors will use this number to see if the treatment that they're prescribing is improving.

Dr. Richard Lai DPT LAc [00:09:26]:

So for example, they would give a patient like that bronchodilators, And then later, they would retest to see if the bronchodilator medication is improving. So they would see if there's an improvement in this ratio of FEV one to FVC. Now if you look closely at this table, the severity of COPD goes up as your FEV ratio decreases compared to what would be expected of someone who is your age and your height. So for example, let's say you're a 35 year old woman. You're able to expire 1.5 liters in one second. And for your age and your height, it's predicted that you'd be able to get 2.5 liters out. So your 1.5, which is what you can do, and what you're expected to do for your age and height is 2.5. 1.5 divided by 2.5 is 0.6, which is 60%.

Dr. Richard Lai DPT LAc [00:10:17]:

So your FEV one would fall into gold stage 2, which is an FEV one that falls between 50% and 80%. And, of course, to be classified into any of these stages, your FEV one to FVC ratio would be less than 70%. Alright, everyone. So that actually brings us to the end of this episode. And if you wanna find out more about COPD straight from the global initiative, you can go to their website to get Access to all of their resources for learning about obstructive lung diseases. And I'll actually link their website in the description below. And And if you want a study guide to go along with this episode, just go to the podcast section of my website, which this episode is episode number 65 on COPD. Alright, everyone.

Dr. Richard Lai DPT LAc [00:10:58]:

Until next time. God bless, and happy studying.

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