 Well, hi everyone. This is Donna Prosser, Chief Clinical Officer at the Patient Safety Movement Foundation here to bring you another COVID-19 update. I'm very excited today to be joined by Dr. Albert Rizzo, who is the Chief Medical Officer at the American Lung Association. Welcome Dr. Rizzo. Thank you. Tell us a little bit about what you do there at the American Lung Association. Sure. Well, I'm still a practicing pulmonary physician in Delaware at Christianity Care Health System, but I've been a longtime volunteer at the American Lung Association probably for over 30 years. But the last couple of years they brought me on board as a Chief Medical Officer, mainly to help promote their mission, which is a combination of research, education, and advocacy, and certainly reaching out to groups like yours, trying to provide as much education we can about different topics. And right now, as we all know, the big topic is, you know, viral diseases, respiratory diseases from COVID-19, and how can we best prepare everybody? Well, you know, we hear an awful lot about pre-existing conditions right now, and that would be the population that you serve. Tell us a little bit about your patient population and why those chronic lung problems pose such an issue right now. Sure. Well, as a pulmonologist, certainly I see patients with asthma, chronic bronchitis, COPD, some lung cancer, pulmonary fibrosis. So there's a lot of chronic pulmonary illnesses. Probably the most common tend to be asthma and COPD. And as we've learned, a lot of things from COVID-19 over the last few months, one of the things, unfortunately, we've learned is that there are some vulnerable populations, and that certainly includes the elderly. It includes those with comorbidities, like the lung diseases I just mentioned, as well as heart disease and diabetes. Anything that really puts them at compromise when they start to get infected with a viral infection like COVID-19, that just attacks the lungs primarily at this point. It's not the only part of the body that gets affected, but the lungs seem to be the main focus. And certainly when oxygenation becomes a problem, the rest of the body's organs suffer as well. And if you have an underlying chronic condition like asthma or COPD, your lungs are already a little bit compromised and just can't handle it as often. One thing I do reassure patients with lung disease is that certainly keeping on your normal maintenance medications doesn't necessarily mean you're going to get more likely to be infected. It's just if you do get infected, you have a little higher risk of complications because of those things I just mentioned, the underlying chronic condition. So then in addition to that, do you have any other recommendations for folks with lung conditions? I know there are a lot of folks who feel like they have to stay shut in at home. Any recommendations for them? The main thing is certainly a lot of patients with lung disease have chronic symptoms like cough and shortness of breath. And they keep hearing that cough and shortness of breath are common signs and symptoms of COVID-19. So you want to know what your baseline is and you want to be able to notice if there's a difference, especially if it seems to be associated with things like a fever or some GI symptoms. And I think in this whole realm of what do you do when you have certain symptoms, these are populations of patients that hopefully have had a good dialogue with their providing physician, their caregivers, so that when something does develop out of the ordinary, they're able to communicate nowadays using my phone or telemedicine and tell them what the change in the symptoms are. It may simply be a mild flare in their underlying condition, but they need to get some feedback from their provider as to is this something that needs to be escalated to a little bit more of an evaluation or can it be safely handled at home with some frequent monitoring? So I think patients with chronic lung conditions need to be on their usual medicines, know how to communicate with the provider and kind of keep attuned to any changes in their symptoms. You know that chronic often shortness of breath are part of their symptoms, but it's the change that we want to be concerned about. Great, great advice. What about for hospitals or clinicians that are working in hospitals? Very often, hospitalists that are caring for patients that are hospitalized with COVID-19 are not their primary care provider. Do you have any recommendations about how they should specifically care for patients with an underlying lung condition? Well, I think fortunately, most hospitalists now know that COPD patients tend to be a large population of their inpatients, even before COVID-19. Unfortunately, COPD was a recurrent reason for people to be admitted. So I think by and large, hospitalists know what to look for. I think now they just have to be more attuned to the fact that this does represent a population that may get decompensate more quickly, doesn't have the reserve to handle increased respiratory symptoms. But certainly from what I'm seeing in the emails that I see, communications on webinars, this population is being treated specifically because they have the comorbidities, along with other people with heart disease and cancers and diabetes. We kind of know that they're at risk and we take the extra precautions. We've also heard a lot about patients when they are hospitalized requiring mechanical ventilation. Are you aware of any risks to these patients? Let's say they don't have a chronic lung disease. Are there risks to them to acquire one as they move forward if they have successfully gotten off the ventilator? Well, the critical illness that requires you being on a ventilator. Unfortunately, I already put you in a category of somebody who's had a more severe complication of the disease. Many individuals who survive mechanical ventilation from other conditions like adult respiratory distress syndrome or ARDS. We know that there's a subset of them that will have a fairly long time to recover back to baseline, certainly measured in months, sometimes a year. And there are some people who will be left with some scarring and may never get back to a more normal respiratory function prior to the illness. And the same thing could apply to individuals who already have chronic lung disease. Certainly, as I mentioned before, they have less reserve. So certainly if they get scarring in their lungs, they may have a harder time getting back to a pre-COVID-19 infection baseline. But I think the message is that many patients with comorbidities are surviving, getting off ventilators. And it is just a matter of variation as to how quickly somebody returns to a more normal level of function, knowing that it may take a little bit longer than somebody who has a chronic illness. Right. Well, great. Thank you for reminding us of that because it is true. There are people who are successfully getting over this illness and we really appreciate your time talking with us today. Do you have any other final thoughts for us? I think the main message is communication, making sure that you're communicating with your family members, your caregivers at home, and also more importantly with your providers so you can have that open communication when questions come up or symptoms change so an intervention can be put in place if necessary. Great. Well, thank you very much for your time today, Dr. Rizzo. We really appreciate you being here with us. Thank you.