(Figure 1: COPD)
Chronic obstructive pulmonary disease, commonly known as COPD, is a “progressive life threatening lung disease that causes breathlessness initially with exertion and predisposes to exacerbations and serious illness” (WHO, 2017). COPD can be diagnosed by simple spirometry testing, which records lung volumes and flows. “Chronic obstructive pulmonary disease is a lung disease that is characterized by a persistent reduction of airflow,” (WHO, 2017) which can be seen with spirometry testing. As seen above in figure 1 COPD is a chronic disease comprised of emphysema, chronic bronchitis, and asthma. “The primary cause of COPD is exposure to tobacco smoke, either active smoking or second hand smoke” (WHO, 2017). In rare cases COPD can be caused due to genetics and is referred to as alpha-1 antitrypsin deficiency, however, we will be discussing COPD caused by tobacco inhalation in this blog post. COPD is a non-curable chronic disease, however, symptoms can be relieved with treatments to increase overall quality of life. Treatments include but are not limited to, home oxygen, inhaled medication, pulmonary rehabilitation, and smoking cessation. As COPD advances in severity government funding helps with treatment costs, varying depending on the province. The COPD population has always been vulnerable during cold and flu season, however, during COVID-19 the vulnerability of this population has increased drastically. There are several social-economic factors that play a role in determining if someone will develop COPD, which will be discussed in further detail in this blog post.
(Video 1: Understanding COPD)
According to the Government of Canada(2020) determinants of health are the broad range of personal, social, economic and environmental factors that determine individual and population health. Government of Canada(2020) lists determinants of health including; income/social status, employment, education/literacy, environment, behaviours, health services access, genetic endowment, gender, culture, and race. Focusing on income and environment it is important to note, “more than 90% of COPD deaths occur in low and middle income countries.” (WHO, 2017). The social ecological multilevel model of health (figure 2) looks into health determinants at the individual, interpersonal, community, organization, and policy/enabling environment levels.
(Figure 2: Social Ecological Model)
On the individual level knowledge, attitudes, and behaviours come into play. These factors may affect someone becoming a smoker, and ultimately developing COPD. In my current practice as a Respiratory Therapist I encounter many COPD patients who have a lengthy smoking history. Many of these patients inform me that knowledge about the harmful effects of smoking were not readily available to them in their younger years. The lack of information made it difficult for the population to make informed decisions regarding smoking. COPD patients also state that they held the attitude that smoking would not affect their health even after learning about the harmful affects. For many of my COPD patients smoking is a learned behaviour that became a habit. Smoking cigarettes, as we know, is a very addictive habit that becomes a daily behaviour for many. The next level is the interpersonal level; this includes family, friends, and social networks. Smoking starts for many as a social habit around friends and family. Smoking may also be a habit of the parents who’s children grow up in a smoking environment and become smokers themselves. At the community level the community someone lives in can affect his or her smoking habits. If the community someone lives in allows smoking in parks, public transit, and businesses it may increase the chance of someone becoming a smoker and continuing to smoke. Years ago smoking was permitted inside businesses, making smoking more socially acceptable. Certain cultures and environments are more accepting of cigarette smoking, which can effect the population. If the community a smoker lives in has easy access to smoking cessation and education then they may be more likely to quit. If health events were available in the community it would increase knowledge and aid in decreasing the smoking population. The fourth level is the organizational level. At the organization level, schools for example, may take it upon themselves to offer guidance for smoking cessation, smoking education, or smoking cessation kits for students. If schools have the resources to supply smoking cessation tools to their students this could help decrease the smoking population and in turn decrease cases of COPD over the years. The final level is policy/enabling environment. Provincial and federal laws are in place to regulate the smoking of cigarettes. These laws help control where a person is allowed to smoke and how tobacco products can be sold.
(Figure 3: The Lungs on COPD)
COPD patients are a vulnerable population during cold and flu season, as seen above in figure 3 their lungs are unhealthy at the best of times. The current COVID-19 pandemic has heightened the vulnerability of the COPD population. According to the Government of Canada (2020) people of any age living with a chronic disease are at higher risk, this includes lung disease, heart disease, diabetes, and obesity. From my experience with the COPD population they often have comorbidities such as diabetes, cardiac disease, and/or obesity. This places the COPD population at extreme risk with poor outcome if they contract COVID-19. It is important that we as healthcare providers work carefully to optimize COPD management. Many patients with severe COPD live in retirement lodges or long term care facilities which raises concern around community transmission of COVID-19. “Increasing concern regarding the challenges of implementing physical distancing measures in congregated living situations such as retirement homes and long-term care facilities need to be urgently addressed” (NCIB, 2020). Addressing the risk among the aging population in retirement homes, in my opinion, was well done in Central Alberta. Visitors were limited to essential only, families were meeting with loved ones through windows, and meal times were staggered to decrease the number of people per table.
(Figure 4: Alberta Health)
In Alberta patients living with COPD can acquire government funding for medical needs such as home oxygen. The government body in Alberta is Alberta Aids to Daily Living (AADL). COPD patients who require home oxygen to increase their quality of life must undergo testing to prove that they need supplemental oxygen before AADL will supply funding. Testing includes pulmonary function testing (PFTs), arterial blood gas (ABG), and 6-minute walk tests. If a patient meets the required criteria they will receive home oxygen from a private vendor at no cost to the patient. COPD patients would widely benefit from telemedicine, especially during the current COVID-19 pandemic. Using telemedicine for patient assessments and education would decrease contact for the high risk COPD population. The limiting factor to using telemedicine is socio-economic status and geographic location of patients. For some elderly, chronically ill patients money is not in abundance, in these cases the patient may not have access to the supplies needed for telemedicine to be successful. In addition to this Alberta has many rural areas where cell service is not strong enough to conduct virtual assessments by phone. There are many determining factors that play a role in the level of care someone receives, access to a family doctor, proximity to a hospital, cell service, and reliable transportation to name a few.
We can conclude that there are many factors at play for the current and future COPD population, from environment, smoking habits, tobacco addiction, and socio-economic factors. Currently with COVID-19 rates climbing yet again during the second wave there is increase concern surround the already vulnerable COPD population. As healthcare workers and the population as a whole we must advocate for the vulnerable population to the best of our abilities.
References
Animated COPD Patient. (2014, August 15th). Understanding COPD[Video]. YouTube. Retrieved on December 6th2020, from
Government of Alberta (2020). AADL – Eligibility and application for benefits. https://www.alberta.ca/aadl-eligibility-and-application-for-benefits.aspx
Government of Canada. (2020, Oct 7). Social Determinants of Health and Health
Inequalities. Retrieved on October 16th2020, from https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html
NCIB (2020). Key Highlights of the Canadian Thoracic Society’s Position Statement on the Optimization of COPD Management During the Coronavirus Disease 2019 Pandemic. Retrieved on November 22nd 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228892/
World Health Organization (2017). Chronic Obstructive Pulmonary Disease. Retrieved on December 6th, 2020, from https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)
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