Our lungs utilize oxygen, which enables us to breathe, live, love, and laugh. The lungs can be taken for granted sometimes, always taking the brunt of the ever-increasing air impurities. When our lung function is compromised, we recognize the fact that breathing is the only thing that truly matters. Among the most common chronic respiratory diseases in the world are asthma and chronic obstructive pulmonary disease (COPD).
Lungs Credit: Andreas Heinemann
In Canada, a total of 2.0 million people have COPD, and 3.8 million people over the age of one have asthma. COPD is typically distinguished from Asthma by persistent respiratory symptoms and chronic airway inflammation. Asthma is typically characterized by acute airway inflammation temporarily relieved by bronchodilators.
These diseases are significant public health issues in this part of the world. People who have asthma or COPD may find it difficult to participate fully in daily activities such as going to school, working, or socializing. Sadly, 65% of Canadians who have asthma claim that their symptoms keep them from working out. Given the rising incidence of both asthma and COPD, there is also an overall burden in terms of lost productivity and healthcare expenses.
This article seeks to expand on the need for both patients and healthcare workers to be empowered with the right working equipment, good working relationships, and the right working environment. It also buttresses the need for improving the self-management of these conditions.
The landscape of asthma and COPD in Quebec
Table of Contents
In Quebec, approximately 594,000 people have been diagnosed with COPD. This value is estimated since the condition is underdiagnosed. It is said that 60% to 85% of people with the disease are ignorant of it. In Canada, COPD is currently the fourth most common cause of death, and in Quebec, it is the main reason for hospitalization. The Atlantic Provinces and Quebec have the highest COPD death rates.
Implementing the management guidelines for chronic respiratory diseases can be hampered by several obstacles, and managing them in primary care remains difficult. In the diagnosis and treatment of COPD, primary care services are crucial because they keep track of the disease’s development, exacerbations, medication compliance, and specific action plans. Patients who only see primary care doctors, however, are less likely to receive treatment that complies with Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) guidelines.
The ability of primary care teams to provide this type of patient-centered comprehensive healthcare approach is impacted by several constraints which include poor choice of pharmacotherapy, ignorance of the clinicians, and lack of counseling on smoking cessation.
Statistics show that two-thirds of patients receive insufficient drug therapy leading to advanced illness, impaired lung function, worsening state of health, increase in the likelihood of COPD-related hospitalizations, and increasing healthcare costs. When evidence-based therapies, including preventive interventions, are not applied effectively, the above-mentioned sequelae ensue.
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Furthermore, barriers at the patient level include a lack of education and motivation to institute behavioral changes. Organizational challenges currently being observed across the board include fragmentation of COPD care services, alongside a lack of infrastructure for communication and information exchange, referral channels, and self-management planning tools.
Empowering healthcare professionals
To improve the quality of healthcare being delivered, the application of a more holistic and integrated method of care to the clinical practice guidelines is being advocated for. To facilitate this process, the quality improvement collaborative (QIC) strategy has been created to aid healthcare professionals in adopting these guidelines and quality improvement tactics which would hopefully lead to a turnaround in the health system, improved disease outcomes, and enhanced utilization of medical services.
In order to improve the management of chronic illness in primary care, Quebec has adopted COMPAS+, a quality improvement (QI) partnership. This has been in motion since 2016.
The COMPAS+ program is executed by Quebecs Ministry of Health and Social Services (MSSS) and the Institut national dexcellence en santé et en services sociaux (INESSS). The main objectives of this program are to improve service delivery for priority chronic diseases, increase interprofessional collaboration, and involve primary care providers and patients in quality improvement (QI).
So far, 14 locations in four different regions of Quebec were engaged in the COMPAS+ intervention between 2016 and 2019. This served to improve the primary care services delivered to people living with chronic respiratory diseases including COPD.
Patient education and self-management
Self-management programs have been cited as a crucial component of managing COPD. This seeks to lessen COPD-related impairments while also enhancing physical, mental, and emotional health and quality of life.
Most patients are willing to play a role in the management of their condition since it improves their ability to control it. However, an inept knowledge of the nature and course of the disease, the way it’s controlled, and basic self-management principles which are individualized, is needed to be successful at this.
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Considering that there is a high rate of poor adherence to self-management guidelines amongst asthma and COPD patients, interventions that enhance the utilization of chronic disease management approaches have the potential to produce favorable health outcomes.
Self-management will be successful if patients create action plans highlighting the steps they will take to put their strategies into practice. These can be oral or written, based on predetermined templates, or customized for every patient. This action plan makes patients extremely aware of their responsibilities towards their health.
Leveraging technology for asthma and COPD management
The demand for COPD and asthma treatment may be met with the help of efficient, secure, usable, and entertaining digital healthcare technologies that can be incorporated into international healthcare systems.
The use of digital technology can take a variety of forms and is not constrained by individual preferences or healthcare systems. They are numerous and include applications, emails, mobile phone messages and notifications, and remote recording or monitoring devices. Digital health applications can offer solutions like education programs to teach the right inhaler technique and encourage lifestyle modifications, tools that monitor and keep track of self-management plans, and a whole lot more. Also, tools that allow tracking and better control of symptoms are available.
The Telehomecare Monitoring Service is a Quebec-based platform for educational content and individualized follow-up. This device caters to COPD patients helping them prevent exacerbations and allowing for prompt assistance from the medical team.
Community and support systems
One downside to the self-management of chronic diseases is the lack of or inadequate social support. This may even be a greater obstacle for COPD patients because dyspnea and exertion on physical activities may drive patients to limit social activities causing social withdrawal and psychological imbalance. It is also associated with decreased sensation of smoking, increased visits to the emergency room, and increased rate of hospitalization.
The provision and distribution of psychological and material support will prove beneficial as it will enhance a patient’s ability to manage their diseases. The involvement of individuals, support groups, and organizations provides a better disease outcome.
Self-management group meetings have the potential to widen peer networks and groups since they provide possibilities for learning, a sense of validation for lived experience, and the chance to meet and connect with new friends.
Legal and Policy Framework
The Canadian Lung Association makes sure that policymakers and the government have adequate knowledge and experience necessary to create policies that will favor patients with chronic respiratory diseases.
A robust but adaptable regulatory system is essential to truly advance the fight against COPD and provide new and improved medications and technology. The regulation of the pharmaceutical and medical device sectors should encourage safe and effective innovations that improve patient therapy and life expectancy.
State and federal regulations should support procedures and initiatives that guarantee patients have access to standard care and can obtain whatever treatments their doctors deem to be the most effective for them. It is crucial that the patient community participate in the creation of quality improvement initiatives launched or rewarded by the federal and state governments, and that these initiatives are widely publicized.
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The Pharmaceutical Drugs Directorate(PDD) should partner with the community and all stakeholders to gain knowledge on the key factors in the management of chronic lung disease and to also look for ways in which patients can be involved in decision-making.
Conclusion
COPD and asthma are lifetime progressive illnesses that reduce the quality of life drastically if not handled holistically. Its prevalence in Quebec has risen over time. To effectively manage these conditions, a holistic approach should be employed involving empowering healthcare professionals, proper patient education, using relevant technology, strong yet flexible support systems, and supportive overarching policy frameworks.
The effective management of these conditions by integrating self-management through the participation of both patients and doctors provides a better quality of life.
Resources
https://telesantequebec.ca/en/patient/services/
https://telesantequebec.ca/professionnel/services/
https://www.rqesr.ca/fra/outils-educatifs/outils-les-plus-utilises.asp
References
Bourbeau J, Farias R, Li PZ, et al. The Quebec Respiratory Health Education Network: Integrating a model of self-management education in COPD primary care. Chronic Respiratory Disease. 2018;15(2):103-113. https://doi.org/10.1177/1479972317723237
Vachon B, Giasson G, Gaboury I, Gaid D, Noël De Tilly V, Houle L, Bourbeau J, Pomey MP. Challenges and Strategies for Improving COPD Primary Care Services in Quebec: Results of the Experience of the COMPAS+ Quality Improvement Collaborative. Int J Chron Obstruct Pulmon Dis. 2022;17:259-272
https://doi.org/10.2147/COPD.S341905
Wilkinson, Tom. Digital Healthcare in COPD Management: A Narrative Review on the Advantages, Pitfalls, and Need for Further Research.Therapeutic Advances in Respiratory Disease, 1 Jan. 2022, https://doi.org/10.1177/17534666221075493
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