Dear Dr. Roach: What signs and/or symptoms do you need for a doctor to determine you have chronic obstructive pulmonary disease (COPD)?
R.K.
The diagnosis of COPD is suspected in people who are at risk for the disease and note one of two cardinal symptoms: cough or dyspnea. (A “symptom” is what a patient identifies by history, while a “sign” is noted on a physical exam. Cough can be both a symptom and a sign.) Dyspnea is usually described as shortness of breath, a sensation that a person can’t get enough air. Some people with COPD may have very subtle symptoms.
Smoking is the biggest risk factor for COPD, but there are other causes, including other chemical exposures (industrial exposures and home cooking fires are less common now, but are historically important causes of COPD); scarring lung disease; and a genetic cause, a condition called alpha-1 antitrypsin deficiency.
The diagnosis is confirmed most often by tests of lung function, which are breathing tests to look at the physiology of the lung and its ability to exchange oxygen and carbon dioxide. Sometimes, the diagnosis can be supported by an X-ray or CT scan, but pulmonary function testing is the best way to determine the severity of COPD.
We do have ways of slowing down lung decline in COPD, one way being smoking cessation for current smokers, but some of the medications we use also help reduce ongoing damage.
Dear Dr. Roach: Is it true that Trulicity may cause serious side effects, including thyroid tumours and cancer, as well as pancreatitis?
J.R.
Dulaglutide (Trulicity), like semaglutide (Ozembic) and liraglutide (Victoza), are in a class of drugs called GLP-1 receptor agonists, which have several actions, such as increasing insulin release by the pancreas in response to meals. Initial studies on lab rats showed an increase in an unusual type of thyroid cancer, but studies have not yet shown this in humans. Still, people at an increased risk for this thyroid cancer (a family history of medullary thyroid cancer or of multiple endocrine neoplasia, type 2A or 2B) are not recommended to take this medication.
There are also reports of pancreatitis in people taking this medication, but it isn’t clear whether the medicine is responsible for the pancreatitis. It’s unwise to use this class of medication in people with a history of pancreatitis.
Dear Dr. Roach: I’m 93, in excellent health and I’m taking atorvastatin daily. My cholesterol results are excellent. I wonder if I should continue the statin.
B.F.
If you were started on a statin because of blockages in the arteries, especially if you had a heart attack or stroke, I recommend continuing it. If you have been on the medication to prevent a heart attack or stroke, I say it is up to you. If the medication is causing side effects, or if it really bothers you to take it, you can certainly stop.
However, I believe the atorvastatin continues to reduce your risk of a heart attack and still gives you some benefit. There is no need to stop it simply because of your age. Remember, your cholesterol results are excellent on the medicine and aren’t going to be as good if you stop it.
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