Chronic Disease Management and Prevention: COPD
- jc645587
- Nov 5, 2022
- 7 min read
Updated: Dec 6, 2022
What chronic diseases are relevant to your practice? Why are these relevant or common in your practice? No more than three please, unless you are offering a simple list.
Chronic diseases that are relevant to my practice as a respiratory therapist include: Chronic Obstructive Pulmonary Disease (COPD) and asthma. Chronic Obstructive Pulmonary Disease (COPD) is a term for multiple chronic respiratory diseases that include chronic bronchitis and emphysema (Benady, 2010). COPD is common in my practice as it is mainly caused by smoking. Patients that are diagnosed with COPD often have difficulty breathing, clearing secretions, and managing their symptoms as the disease progresses. There is no cure for COPD and as the disease progresses and patients age, the main form of treatment is symptom management including oxygen therapy, medications, pulmonary rehab and lung transplant (Benady, 2010).
Being diagnosed with COPD places a significant burden on patients and the healthcare system in Canada. On average, conditions such as COPD and asthma attribute to many emergency room visits and hospital admissions, with the economic burden of COPD exacerbations in Canada alone is estimated to be $646–736 million/year (Statistics Canada, 2020). These high costs have led to a growing effort to understand the prevalence and burden of COPD (Statistics Canada, 2020).
Asthma is another chronic disease that I see quite frequently in my practice. Asthma is a chronic inflammatory disease of the airways that causes symptoms like shortness of breath, chest tightness, coughing and wheezing (Public Health Agency of Canada, 2018). Asthma causes inflammation and narrowing of the bronchial tubes, which leads to limited airflow and difficulty breathing. When people with asthma encounter triggers, these muscles react by tightening even more, the lining of the airways swell and the airways can fill up with mucus. This makes breathing very difficult and leads to asthma symptoms or asthma exacerbation, also known as an asthma attack wheezing (Public Health Agency of Canada, 2018). There is no cure for asthma, but with proper treatment it can be managed.
Asthma is usually diagnosed in childhood, by the patient taking a methacholine challenge breathing test. Ideally, patients need to be >6 years of age to complete a spirometry test and start the asthma diagnosis. Asthma affects more than 3.8 million Canadians, including 850,000 children under the age of 14 (Public Health Agency of Canada, 2018). In Canada, asthma is the third-most common chronic disease. Every day, over 300 Canadians are diagnosed with asthma, and tragically every year an estimated 250 Canadians die from an asthma attack (Public Health Agency of Canada, 2018).
Working as a respiratory therapist (RT), I diagnose COPD and asthma by having patients complete a spirometry test and later a methacholine challenge test. Many of the patients I treat daily at the hospital have COPD and asthma to some degree and the more severe the disease, the more likely the patient will have at least one hospital admission due to their chronic disease a year. My role as an RT is also to educate, optimize medications and treatments, provide patients with an action plan, and make sure they can manage their disease at home, and know when to come to the emergency department.
What are the rates of the chronic diseases you encounter in your practice or that you study in the population? Be sure to cite evidence. What are the rates in your region (provincial, territorial, municipal, or other region, or relevant subgroup)?
On Prince Edward Island, patients living with COPD account for the most hospitalizations of all chronic diseases. Chronic Obstructive Pulmonary Disease is a major Canadian public health concern (Canadian Chronic Disease Surveillance System (CCDSS), 2018). In 2010, the annual societal cost of COPD in Canada was an estimated $4.52 billion dollars, and it is expected to reach $3.61 B ($7.33B undiscounted) per year in 2035 (Najafzadeh et al., 2012). Chronic lower respiratory diseases (including COPD) are the fifth leading cause of death in Canada, and the fourth leading cause of death in PEI (Statistics Canada, 2019). An estimated 3.9% of Canadians and 6.4% of Islanders 12 years of age and older are living with COPD (Statistics Canada, 2020). Chronic Obstructive Pulmonary Disease places a significant burden on the health care resources of PEI. Islanders with COPD are using health care services at a much higher rate than those without COPD (Department of Health and Wellness, 2014). As a primary diagnosis for hospital admission, COPD is ranked second in PEI, which accounts for 3.2% of all hospital admissions in the province (Canadian Foundation for Healthcare Improvement, 2015).
What are the primary determinants of the chronic diseases you encounter in your practice or that you study in the population? Federal and/or provincial evidence should be available.
Smoking is the biggest risk factor for chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema. It increases your risk of both developing and dying from COPD. Approximately 85 to 90 percent of COPD cases are caused by smoking (Canadian Chronic Disease Surveillance System (CCDSS), 2018). Female smokers are nearly 13 times as likely to die from COPD as women who have never smoked; male smokers are nearly 12 times as likely to die from COPD as men who have never smoked (Statistics Canada, 2019). Other risk factors include: exposure to air pollution, second hand smoke, working with chemicals/dust/fumes, genetic condition alpha-1 deficiency and history of childhood respiratory infections (Canadian Foundation for Healthcare Improvement, 2015).
In your area of work, how do you handle chronic disease? Is this consistent with best practice? What practice guidelines do you follow? Which are you familiar with?
In my line of work, handling chronic disease starts with disease prevention. Within Health PEI, RTs are consulted for smoking cessation with any patient who states they are a smoker on admission. Through our consult, we discuss, prescribe, and follow up with nicotine replacement therapy. Throughout Health PEI, the guidelines that RTs use is the Ottawa Model for Smoking Cessation. This is a highly effective approach to quitting smoking and the model is best practise in smoking cessation across Canada (Department of Health and Wellness, 2014). In 2003, PEI introduced the Smoke-free Places Act banning smoking in all public spaces. This Act has helped reduce the amount of ETS exposure in public spaces. Although PEI was the first province to institute comprehensive, province-wide, anti-smoking legislation in Canada, the most recent rates indicate a potential increasing trend in exposure (Department of Health and Wellness, 2014).
Early detection and diagnosis is also important when talking about COPD, as it can go undiagnosed or just because a patient has smoked they will be misdiagnosed as having COPD. Early detection is completed by a spirometry (breathing test that measures lung function) test (Global Initiative for Chronic Obstructive Pulmonary Disease, 2020). Generally patients that are age >40, have a smoking history, regular cough, production of phlegm, shortness of breath, wheeze on exertion, or frequent colds or viral illnesses that last longer than normal can be referred for a spirometry test (Global Initiative for Chronic Obstructive Pulmonary Disease, 2020). Throughout Health PEI, spirometry tests are performed in primary care clinics, at the RT clinic at the QEH hospital and the PCH hospital. These tests are interpreted by a respirologist and patients are referred to a specialist when appropriate (Canadian Foundation for Healthcare Improvement, 2015). The spirometry results will provide a classification of airflow obstruction. The practice guidelines I use to determine treatment are the GOLD guidelines (Global Initiative for Chronic Obstructive Pulmonary Disease, 2020).
Image: (GOLD COPD Guidelines, 2022).
When a patient comes into hospital with COPD, Health PEI has the COPD Pathway which we start the patient on. This pathway includes: education, consulting physiotherapy, pharmacy, and respirology if appropriate, reviewing puffers and technique, reviewing vaccines, providing a COPD action plan, providing secretions clearance help such as an Aerobika, and considering home oxygen. Also patients can be referred to pulmonary rehab or the Inspired program. At Health PEI, we follow the GOLD Guidelines for COPD management and treatment (Department of Health and Wellness, 2014).
The Inspired program is unique to Atlantic Canada and stands for Implementing a Novel and Supportive Program of Individualized Care for Patients and Families Living with REspiratory Disease (INSPIRED) is a proactive hospital to home program aimed at improving the transition and discharge process (Canadian Foundation for Healthcare Improvement, 2015). Inspired is a collaborative program with acute care hospitals, primary care and home care that includes: a telephone call following hospital discharge, a home visit(s) by a COPD Educator, help with navigating the health care system and gaining access to programs and/or services, interventions and management of COPD, an opportunity to discuss advanced care planning, and a contact number if you have questions or concerns regarding your COPD (Canadian Foundation for Healthcare Improvement, 2015).
Image: (Canadian Foundation for Healthcare Improvement, 2015).
Image: (Canadian Foundation for Healthcare Improvement, 2015).
Resources
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Department of Health and Wellness. (2014). Prince Edward Island chronic obstructive
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Canada, 2018. https://www.canada.ca/en/public-
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World Health Organization. (2017). Chronic obstructive pulmonary disease (COPD).
pulmonary[1]disease-(copd)
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