Region ramps up efforts to diagnose and treat COPD
|Respiratory therapist Kristin Peleck holds a portable spirometer as respiratory therapist Sherri Vautour (left), Respiratory Therapy Manager (Acute Care) Craig Hillier and respiratory student Sheila De Los Santos look on.
BY BOB ARMSTRONG
Winnipeg Health Region
Wave, March / April 2017
Karen Murray’s problems started about three years ago.
“I was just having shortness of breath and chest pain,” says the 56-year-old Winnipeg woman.
“I thought, you know what, I’ve got to go see a doctor. I knew something was wrong.”
Initially, Murray thought the pains were caused by a problem with her heart. But when she was examined by a cardiologist, he could find nothing wrong, so he referred Murray to a respirologist, who conducted more tests.
And that’s when Murray got the news. The chest pain she was experiencing had nothing to do with her heart, but it had everything to do with her lungs.
As it turned out, Murray had something called chronic obstructive pulmonary disease (COPD), a debilitating condition that constricts the airways and damages the small sacs in the lungs, making it difficult to breathe.
In technical terms, COPD occurs when the alveoli – the tiny sacs where oxygen and carbon dioxide are exchanged – are damaged, usually by airborne contaminants. Gases are exchanged at the surfaces of the alveoli, and the large numbers of alveoli inside the lungs, like grapes clustered on a vine, have a large surface area. But as the alveoli are damaged, they end up forming larger “blobs” instead of clusters of individual alveoli. As well, the airways in the lungs become inflamed, creating a tighter space for the air to move when inhaling or exhaling.
News of the diagnosis took Murray by surprise. Although COPD, an umbrella term that includes emphysema, bronchitis and some other lung diseases, is often linked to smoking, it can also be caused by inhaling pollutants, such as welding fumes and grain dust.
And while Murray used to smoke, she had given up the addiction years earlier – long before she had started to experience any health problems.
“I thought I had dodged a bullet because I’d quit smoking,” she says. “It (the diagnosis) was a real eye-opener.”
Unfortunately, Murray is not the first person to be taken aback by a diagnosis of COPD. Nor will she be the last, according to Craig Hillier, Regional Manager, Respiratory Therapy (Acute Care) with the Winnipeg Regional Health Authority. In fact, he suggests that as many as four per cent of Winnipeggers – about 28,000 people – have diagnosed or undiagnosed COPD.
Many of these people have been referred to the Region’s Pulmonary Rehabilitation Program. The program is run out of three facilities – the Wellness Institute at Seven Oaks General Hospital, Deer Lodge Centre and Misericordia Health Centre – and specializes in helping people with COPD and other lung conditions.
As Hillier explains, COPD tends to creep up on people slowly. But it can also cause an “exacerbation” – a sudden worsening of the condition that health-care providers refer to as a “lung attack.”
These lung attacks account for an ever-growing number of patients in the city’s emergency departments, says Hillier. “People with COPD are coming through our hospitals in big numbers,” he says, noting that it is one of the top five reasons people are admitted to emergency.
Indeed, a year after her initial diagnosis, Murray ended up in the emergency department at Concordia Hospital after again experiencing severe chest pains.
At the time, it was thought the pains might have been caused by pleurisy, but it is also possible they were connected to her COPD. In any case, it was following that trip to emergency that Murray was referred to the Pulmonary Rehabilitation Program at the Wellness Institute.
Although COPD is a serious condition that affects many people, it is not a top-of-mind illness for most Canadians. A study carried out by the Canadian Lung Association and the Canadian Thoracic Society a decade ago is still likely relevant today, says Hillier. It revealed that, while 99 per cent of Canadians had knowledge of breast cancer, and similarly high percentages were familiar with other illnesses, fewer than 20 per cent of Canadians were familiar with COPD.
That same study also showed that only a minority of doctors used basic diagnostic tools, such as a spirometry test, which can be used to measure lung capacity, to diagnose COPD and that only a small minority of them felt comfortable interpreting the results of such a test.
The end result is that the first signs of COPD are often missed – because people don’t necessarily recognize the early symptoms, and because doctors don’t always test people who are at risk for the disease.
“We know we are under-diagnosing or diagnosing late,” says Hillier.
Although the condition is often associated with people who are 50 years of age or older, Hillier says the initial stages of the disease can often be discovered earlier in life. “It can be detected (in people) as early as their 30s,” he says. “But we usually see people when they start experiencing symptoms. They say to their doctor, ‘I’m coughing all the time’ or ‘When I walk through the mall with my wife, I can’t keep up with her.’”
As a result, the Region is working to raise awareness about the condition and to improve access to early diagnosis and treatment. As Hillier explains, although there’s no cure for COPD, providing education and therapy programs for people with the disease can offer substantial benefits. “Our goal is to help people feel independent, have a better quality of life, and not have to go to the hospital as often.”
To that end, the Pulmonary Rehabilitation Program, in conjunction with the Region’s Primary Care Program and the Chronic Disease Collaborative, has taken a number of steps.
For example, members of the three programs have developed a clinical practice guideline to make spirometry testing more readily available through doctors’ offices and ACCESS clinics located throughout the city. In addition, the group secured funding from the Manitoba Lung Association to help support the training of 20 health-care providers, including an interdisciplinary team of nurses, physiotherapists, pharmacists and dietitians, to carry out spirometry testing at these facilities.
Carol Schaap, Initiative Lead for the Region’s Primary Health Care Program, says that since the illness is often caused by smoking, an early diagnosis might provide the incentive to quit before the damage gets worse.
The Region is also taking action on the treatment side. Last year, with funding support from the Canadian Foundation for Healthcare Improvement, the Region launched a pilot program at Concordia Hospital called Inspired. This program is designed to optimize and standardize care for COPD and other advanced-stage lung diseases. Included in the project have been educational sessions for family doctors who admit patients to Concordia’s medical beds, in which they learn how to read spirometry results.
Another aspect of the Inspired project focuses on the transition from hospital to the community for COPD patients who are returning home. It is designed to provide a specialized level of care for patients with severe COPD by providing them with education about their condition and access to services designed to support them in their own home, such as home care. Eventually, Inspired will be rolled out to other facilities in the city.
COPD is also being targeted by the My Health Teams initiative, which is designed to support the creation of health-care provider teams in the community to help Manitobans get access to care, says Hillier. Through the My Health Teams approach, funds are being made available so that physicians can have chronic disease clinicians – often nurses with expertise in fields like COPD or diabetes management – working in their offices or clinics.
As Hillier explains, once someone is diagnosed with COPD, the goal is to help the patient manage their condition and prevent them from experiencing a lung attack – and a trip to emergency.
As in Murray’s case, this will often mean a referral to the Pulmonary Rehabilitation Program. About 200 people a year go through the eight-week program, which provides participants with instruction on medications, nutrition, lifestyle adaptations, and signs of possible attacks.
As part of their course, participants also walk, either on the track at the Wellness Institute or in the hallways at the other locations, or use treadmills or exercise bikes. Improving general fitness helps to manage the overall effects of COPD because it helps ensure that even if lung function is impaired, the heart is better able to circulate the oxygenated blood.
Over the eight weeks, participants often find their walking ability is dramatically improved, says Hillier. “We’ve had people come to the program and say that just getting into the shower was a nightmare. But by the time they were finished, they were walking five or six loops around the track.”
The program has had a big impact on Murray’s health.
As she explains, once she was diagnosed with COPD, she started to notice the times she found herself short of breath, such as when climbing the stairs. She also found that breathing could be a challenge in extreme cold and in summer heat and humidity.
Following her diagnosis, Murray started taking medication in the morning to keep her airways open and uses a Ventolin inhaler for occasions when activity or something in the air causes shortness of breath.
Today, with medication and exercise, she’s able to carry on with daily activities like gardening, shopping and her work as a seamstress.
“When I first started the class, I’d get winded after six or eight laps,” she says. “Now I can walk 45 minutes on the track.”
Murray found the activity component of the class so valuable that she and her husband both became members of the Wellness Institute after the program.
“I thoroughly enjoyed the program,” says Murray. “I thanked my respirologist for referring me to it.”
Bob Armstrong is a Winnipeg writer.
Wave is published six times a year by the Winnipeg Health Region in cooperation with the Winnipeg Free Press. It is available at newsstands, hospitals and clinics throughout Winnipeg, as well as McNally Robinson Books.
Read the March / April 2017 issue of Wave