COPD Flute: Musical Medicine--In-Depth Doctor's Interview
Sanjay Sethi, MD, Professor of Medicine and Chief of Pulmonary, Critical Care and Sleep Medicine at UB School of Medicine and Biomedical Sciences, and staff physician with the VA Western NY Healthcare System, talks about a new therapy for COPD patients.
Can you tell me what problems do people with COPD have? What are the difficulties? Why is it so difficult to live with this?
Dr. Sethi: The biggest symptom is dyspnea, shortness of breath. They also have problems with cough and sputum on a daily basis. So those are the major symptoms. They also tend to have fatigue; more advanced cases develop weight loss. They also become more prone to respiratory infections and they get these episodes known as exacerbations.
So they are more prone to pneumonia?
Dr. Sethi: Yes, but they also get more bronchitis attacks. They experience on daily basis; shortness of breath, cough and sputum.
How does it impact them? Are they tired all the time?
Dr. Sethi: They are very limited in their activities and the different symptoms impact them differently. For example, when they have shortness of breath they become more and more inactive and this inactivity makes them deconditioned which makes them more inactive. So they kind of get into this vicious cycle of shortness of breath, inactivity, and deconditioning. The cough and sputum is, of course, very irritating for them. It is also sometimes a social issue and then the sputum itself, bothers them because they feel it in the chest, in the airways, and that essentially can contribute to the shortness of breath and chest discomfort.
Is COPD an umbrella term for a lot of kind of different lung conditions?
Dr. Sethi: Pretty much; mainly chronic bronchitis and emphysema. So those are the two terms we used to use. Bronchitis refers to having a cough and Sputum Emphysema refer to having destruction of the lung, but there was actually used to be a lot of diagnostic confusion because some patients thought they had bronchitis; some thought they had emphysema. So now we have moved back, moved to more of an umbrella term of COPD and the other way to think about it is most of COPD in the US now is smoking related or ex-smokers. I like to call it, smoking-related lung disease, smoking-related chronic lung disease, or other exposures too.
What currently do they have to help them?
Dr. Sethi: In terms of the medications, the most important thing is quitting smoking. That is the cornerstone of treating COPD, but many a times the disease gets established or they have difficulty quitting. Then we have medications. They mainly fall into two categories; bronchodilators and anti-inflammatories. Bronchodilators open up the airways, help them breath better. The anti-inflammatories also help with the breathing, cough, and sputum. Also they help with reducing the exacerbation episodes. All these medications reduce exacerbation episodes, but none of these drugs directly attack the mucus in order to help directly in terms of clearing the mucus.
What are the dangers of having that mucus kind of sit there in their lungs?
Dr. Sethi: Well I think the danger is the discomfort of having it. You have some blockage of the airways. Obviously, it is going to contribute to the shortness of breath and sensations of chest discomfort. Then the other danger is that the mucus is basically a pool. A little amount of mucus is normal, but we don’t cough normally because we have these cilia in our airways which clear the mucus. We don’t normally cough on a daily basis and the amount of mucus is quite small. It is a very thin layer. When people develop COPD, they have more mucus and it also changes in its viscosity and its clear ability. That becomes much more difficult to clear and it then can become a small amount of mucus actually protects against infection, the normal mucus, but if you have excess mucus, you are more likely to get infections too.
Dr. Sethi: Like pneumonia or exacerbations.
Can you tell me, what is the lung flute?
Dr. Sethi: The lung flute is essentially a device known as an oscillatory expiratory device. Essentially, when patients blow into this device, there is a reed in this device and the reed oscillates and this oscillation kind of sends a wave, retrograde, down the airways and that is supposed to help with airway clearance basically, secretion clearance.
Can you please explain what the sound wave technology is?
Dr. Sethi: It is a sound wave so that the reed is tuned in a certain way, to a certain hertz. I think it is in the 14 to 18 hertz range. That particular frequency helps with the, mucus clearance aspect of it.
And how does it help?
Dr. Sethi: It was invented by, or at least part of the people involved, were a Buffalo company and when they came to me and said we have this device which was created by an acoustic engineer. I said well we can, there are diseases I know which I deal with every day where people are very inconvenienced by and they do not have adequate ways to clear their secretions; so can we look at that to see if we can make these people clear their secretions easier. The other thing that came up while we were discussing this was the whole issue of needing to get the mucus from these patients to do studies in. For example, if you are looking for somebody with pneumonia, we want to look at what bacteria are down there. We want to look at sputum of people with suspected cancer. There was this diagnostic need of getting mucus from people reliably and easily also. So that was one aspect. The other aspect was helping people with COPD. There are other chronic lung diseases in which the results are a problem with excessive mucus, like cystic fibrosis, bronchiectasis, and also some patients with asthma. We focused on COPD.
How does sound wave technology clear mucus?
Dr. Sethi: We have not done all the detailed studies because they are rather difficult and expensive and can be quite complicated to look at exactly how fast the clearance happens. The concept is that because of the wave, the mucus kind may be getting liquefied a little bit or shaken around a little bit and because it (the wave) does go into all the airways, so that then results in better clear ability. So the way we use it in our patients is that they blow through it a few times and then they kind of do a huff cough, the kind of cough with an open airway, and because the mucus is now easy to clear, they should be able to bring it up easier.
What have your studies shown so far?
Dr. Sethi: Our studies, we have done two. Initially we started with healthy people; made sure the device is safe and then we went ahead and did the studies. These are pretty much following FDA requirements because the company was interested in getting the indication for the device. So, we said fine. Then we helped them develop the protocol and basically did the studies. The initial one was to look at diagnostic to see if used once, can you get an adequate sputum sample. We compared that with a more traditional method of doing that which is known as hypertonic saline, which is highly concentrated saline. The flute seemed to work as well as that. So, on the basis of that, they went to the FDA and they had a diagnostic indication. Then for the therapeutic indication, we took patients with COPD, who had mucus, which means they had chronic bronchitis and took those patients and either put them on the flute or another device which is marketed for similar purposes known as the acapella and we showed that with both the devices, the patients did feel better. The idea was to show that it is not inferior to the acapella, but at the same time also were able to show that in terms of symptoms and all, actually they did better with the flute.
END OF INTERVIEW
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