Healthy Living in the North

Pulmonary rehabilitation in Prince George

Patient on exercise bicycle monitored by physiotherapist

Pulmonary rehabilitation is a well-established, well-researched intervention to help people with chronic pulmonary diseases cope with shortness of breath, develop activity tolerance, and improve quality of life.

When Dianne Gagne first arrived to take part in the new pulmonary rehabilitation program in Prince George, she had to stop twice to catch her breath en route from the parking lot of the YMCA to the room inside where the program is run. “I couldn’t even shower without getting short of breath,” shared Gagne, whose shortness of breath is caused by chronic obstructive pulmonary disease (COPD) and other complications stemming from a fungal infection of her lungs that first appeared in her 20s.

Robin Roots, a physiotherapist, has seen this before. “For many people with a diagnosis of chronic pulmonary disease,” said Roots, “simply going to Walmart is not an option because of the walking requirement. They are left winded, short of breath, and unable to function.”

It is these challenges and more that the pulmonary rehabilitation program – a partnership between the YMCA of Northern BC, the UBC Department of Physical Therapy, and Northern Health – is working to address. And so far, as Dianne Gagne can attest, it seems to be working. “By the end, I could park and walk up to the room,” said Gagne. “I may never have my full lung function back – I was once an avid cross-country skier – but I’m noticing improvements. I can now do my daily chores without any issues and I’m walking for a full half-hour on the treadmill.”

Pulmonary rehabilitation is a well-established, well-researched intervention to help people with chronic pulmonary diseases cope with shortness of breath, develop activity tolerance, and improve quality of life. Pulmonary rehabilitation includes both an exercise component and education relating to proper disease management delivered by a team of health professionals, including physiotherapists, exercise physiologists, pharmacists, dietitians, respiratory therapists, and specialists.

“Exercise is really the distinguishing feature of this specialized program,” said Roots. “Each participant is assessed and receives an individualized program which is fully supervised. Participants take part in high intensity lower limb aerobic training, strengthening, and balance exercises. Because most participants are on oxygen and many are quite deconditioned, this exercise needs to be very closely monitored. We’ve got some participants on bicycles, some on arm cycles, some on treadmills. It’s all about understanding how much their body can do and designing exercises that increase their ability to take on daily living activities.”

For Gagne, the individualized program really stood out. “They scrutinize you very carefully,” said Gagne. “They would measure my oxygen levels, pulse, and blood pressure before and after exercises. If my oxygen saturation would fall below a certain level, the physiotherapists would stop me. They didn’t push me to do more than I could, but they did challenge me to do as much as I could! The exercise regimes they develop are specific to each individual. Some people were doing 2-3 minutes of activity, others were doing 45. The physiotherapists and students explain things at every step – they would tell me why I would be doing certain exercises.”

The pulmonary rehabilitation program has clearly had a positive impact on Gagne and the other participants. “Participants set their own goals,” said Roots, “and we try to get them there.” For many, the goal is simply to be able to better manage shortness of breath and to function day-to-day without getting short of breath – goals which can significantly improve quality of life. For Roots, however, the research points to an important system level benefit of the pulmonary rehabilitation program. “Research has shown that pulmonary rehabilitation can decrease emergency room visits for acute acerbations of COPD by 40 per cent. We know that there are approximately 300 hospitalizations for COPD per year in Prince George and that the average length of stay for someone with an acute exacerbation is nine days. There is also a readmission rate of 13 per cent. If we can reduce the number of ER visits and prevent hospitalizations, we can save the system a lot of resources.”

Gagne agreed: “This program is a preventive measure. It keeps you out of the hospital and teaches you how to look after your condition on your own.”

The pulmonary rehabilitation program in Prince George is an eight week program, with a cohort of 10-15 participants getting together twice weekly for exercises and education. Anyone with a diagnosis of chronic pulmonary disease can join the program, you just need to complete a pulmonary function test. You can access the rehabilitation program through your physician – ask them about it or tell them about it! Participants have come from as far as Smithers and work is underway to look at how the program can be made more accessible to people living outside of Prince George.

Patients on exercise bicycles monitored by physiotherapist

With one in four people likely to develop COPD in northern B.C., pulmonary rehabilitation programs have the potential to have a massive impact.

According to Roots, the pulmonary rehabilitation program in Prince George, which has received a lot of support from local respirologists Dr. Sharla Olsen and Dr. John Smith, is unique for a few reasons:

  • It represents a partnership between three organizations (a partnership that has also created a second program: cardiac rehabilitation).
  • UBC trains physiotherapy students in northern B.C. and the rehabilitation program offers a valuable site for clinical placements (“It’s win-win,” said Roots). The students provide a valuable service to the program participants while at the same time being trained under the supervision of a licensed physiotherapist.
  • While many pulmonary rehabilitation programs are run out of hospitals, this program is based in the community. This can help encourage participants to think about maintaining the gains they make in the program through active lifestyle opportunities right in the community.
  • The partnership has allowed for the program to be offered at very low cost to participants – just a $10 membership fee.

Both Roots and Gagne have a similar goal: they want more people to know about the program! With one in four people likely to develop COPD in northern B.C., pulmonary rehabilitation programs have the potential to have a massive impact.

“Without the program,” reflected Gagne, “I would be sitting at home, continually going downhill. And though these changes take time, I keep telling my doctors how fantastic the program was. I would like for more people to know about this program – it is available and is really helpful.”

COPD Support Group

Many participants in the pulmonary rehabilitation program see each other one more time each week through the Prince George COPD Support Group. I asked the group to tell me a bit about themselves and this is what the group’s treasurer, Nancy, shared:

The Prince George COPD Support Group, also known as the SOBs (Short of Breaths) gives those diagnosed with COPD (and any other lung issues) a place to learn how to cope with an unforgiving disease. Our group gets exercise directions from a licensed physiotherapist, who also gives informative chats on various issues related to the lungs. As members are all living with the same issues, we have a wealth of lay knowledge to fall back on and share with each other. We have coffee days where we often bring in speakers on a variety of subjects, which goes a long way towards educating us all. We are a dedicated group of boomers helping others as they help us. We are a fun group and invite new members to join – bringing a friend or family member is always welcome!

The group meets every Wednesday, 1 p.m. to 3 p.m. in the AiMHi Gymnasium in Prince George (950 Kerry Street).

What you need to know: Chronic Obstructive Pulmonary Disease (COPD)

Although COPD is the most prevalent condition amongst pulmonary rehabilitation program participants, the program accepts people with any chronic pulmonary disease. Ask your doctor about pulmonary rehabilitation.

From HealthLinkBC.ca:

  • COPD is a lung disease that makes it hard to breathe.
  • COPD is most often caused by smoking. Other possible causes include long-term exposure to lung irritants, neonatal lung disease, and genetic factors.
  • COPD gets worse over time. While you can’t undo the damage to your lungs, you can take steps to prevent more damage and to feel better.
  • The main symptoms are a long-lasting cough, mucus that comes up when you cough, and shortness of breath.
  • At times, symptoms can flare up and become much worse. This is called a COPD exacerbation and can range from mild to life-threatening.

According to the Canadian Lung Association, “chronic lung disease accounts for more than 6% of annual health-care costs in Canada, and COPD is the leading cause of hospitalization.” COPD is the fourth leading cause of death in Canada. The Canadian Thoracic Society reports that a 2008 study “conservatively estimated the total cost of COPD hospitalizations at $1.5 billion a year.”


A version of this article was originally published in the summer 2017 issue of Healthier You magazine. Read the full issue – all about healthy lungs – on ISSUU!

Vince Terstappen

About Vince Terstappen

Vince Terstappen is a Project Assistant with the health promotions team at Northern Health. He has an undergraduate and graduate degree in the area of community health and is passionate about upstream population health issues. Born and raised in Calgary, Vince lived, studied, and worked in Saskatoon, Victoria, and Vancouver before moving to Vanderhoof in 2012. When not cooking or baking, he enjoys speedskating, gardening, playing soccer, attending local community events, and Skyping with his old community health classmates who are scattered across the world. Vince works with Northern Health program areas to share healthy living stories and tips through the blog and moderates all comments for the Northern Health Matters blog. (Vince no longer works with Northern Health, we wish him all the best.)

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Podcasters, meteorologists, physiotherapists, wildfire fighters, and more: The many faces of healthy lungs!

Magazine cover with physiotherapy student and pulmonary rehabilitation client.

Healthy lungs take centre stage in the latest issue of Healthier You magazine!

In reading through the latest issue of Healthier You, it becomes clear that respiratory health is a significant issue in northern B.C.

What is also clear, however, is just how many diverse programs, people, communities, and partners are coming together to better understand and take action on this issue. We can all play a role in promoting health, protecting healthy environments, and preventing lung disease!

Take a look through the latest issue of the magazine online or look for a hard copy of the magazine in local doctors’ offices, clinics, and Northern Health facilities near you! All past issues of Healthier You are also available online.

Here are just a few of the healthy lung stories you can read in Healthier You magazine:

Vince Terstappen

About Vince Terstappen

Vince Terstappen is a Project Assistant with the health promotions team at Northern Health. He has an undergraduate and graduate degree in the area of community health and is passionate about upstream population health issues. Born and raised in Calgary, Vince lived, studied, and worked in Saskatoon, Victoria, and Vancouver before moving to Vanderhoof in 2012. When not cooking or baking, he enjoys speedskating, gardening, playing soccer, attending local community events, and Skyping with his old community health classmates who are scattered across the world. Vince works with Northern Health program areas to share healthy living stories and tips through the blog and moderates all comments for the Northern Health Matters blog. (Vince no longer works with Northern Health, we wish him all the best.)

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The smoke in our air: Tell us how you contribute to cleaner air for your chance to win!

Smoky chimney

We all have a role to play in supporting cleaner air! Smoke and particulate matter don’t recognize borders! Even small reductions in smoke and particulate matter can have a large health impact.

Air quality has made international headlines recently due to an emergency situation in Delhi, India. Their fine particulate matter levels soared well above safe limits. These particles are so small they can enter deep into the lungs and cause a wide range of health problems – especially in children and people with compromised respiratory systems. Schools were shut down and people were urged to limit outdoor activity. Other mitigation measures such as limiting vehicle traffic and halting industrial operations were put into place to combat these extreme conditions.

Air quality: a local concern

The World Health Organization (WHO) has a world map that shows us how Canada compares to the rest of the world. Compared to places like India, we are very fortunate to have very clean air here in northern B.C. Yet we are not immune to poor air quality days! The Central Interior Air Zone Report (2011-2013) and the BC Lung Association 2016 State of the Air Report show us that many of our northern communities exceed provincial or federal air quality standards.

Air quality in the winter

What’s more, air quality can be even more severely impacted in the winter. Our air quality meteorologists tell us that air movement slows or stagnates when it cools down and thus lowers into our valley regions. Particulate matter accumulates in this stagnant air and levels can rise above what is considered safe.

There are many sources of particulate matter including, but not limited to, road dust, vehicle emissions, and smoke from fires. Smoke generated from residential wood heating spikes during these cooler, more stagnant air, days.

Kids & clean air

Breathing cleaner air has benefits for all of us, but children are especially susceptible to the health effects of air pollution. Their bodies are still growing and their lungs are developing. Children also have greater exposure to air pollution because they breathe in more air per kilogram of body weight and they spend more time being active outdoors. Children with asthma or other respiratory conditions are more likely to be affected. Air pollution can trigger asthma attacks and cause respiratory symptoms like coughing and throat irritation, even in healthy children.

Protecting our families, friends, and neighbours

This winter season, I want to remind us all to reduce our contributions to the smoke in our air. There are alternatives to burning wood for heat and if we must burn wood, let’s educate ourselves on how to burn more cleanly and efficiently. This will protect our families and neighbours from harmful pollutants.

If you burn with wood, here are some quick tips:

  • Split, stack, cover, and store wood for 6 months prior to use.
  • Use a moisture meter to check that wood has a moisture content of 20% or less.
  • Use an efficient CSA or EPA certified wood stove.
  • Don’t burn garbage or treated woods.
  • Don’t burn during an air quality advisory.
  • Maintain your chimney and wood burning appliance so it burns clean and is safe.

Even small reductions in smoke and particulate matter can have a large health impact!

Share your clean air tips and stories

How do you or your family reduce smoke or particulate matter during the cooler winter months? We want to read and share your stories about efficient or clean burning practices, alternatives to burning, and other strategies we can all use to minimize the smoke or particulate matter in our air.

Share your stories and tips with us this season for your chance to win a great prize! You’ll also have the chance to tell us why clean air matters to you!

Enter the contest today!

Paula Tait

About Paula Tait

Paula works in Prince George as a Health and Resource Development Technical Advisor, working collaboratively to assess and minimize health impacts related to industrial development. Born and raised in Terrace, she completed her schooling in Edmonton, and started her environmental health career in southeast Saskatchewan in 2005. She has been back in northern B.C. since 2010. Paula enjoys being creative, listening to music, and spending time with family and friends.

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Tales from the Man Cave: The sacred and the evil

Charred pack of cigarettes

Jim’s got a fiery message on the heels of World No Tobacco Day: there is no safe level of exposure to cigarette smoke. There is more support than ever to quit!

Tobacco is not an evil thing in and of itself. It has been used ceremonially for eons in Aboriginal cultures and even used by some for medicinal purposes. As a sacred gift, it has been given and used as a way of making peace or a contract. Historically, it is a very important plant. It has also been used as a pesticide, but this use has largely stopped because it’s also very poisonous when eaten.

Tobacco smoke it is both a relaxant and a stimulant. It can help with depression but may also cause depression. It can make you calm and it can make you more anxious. It is thought to be the type of drug that opens up the brain to develop other addictions and is therefore called a gateway drug.

Boring it is not. Dangerous it is.

So, on the heels of World No Tobacco Day, the main point of this blog is not to disparage the tobacco plant but rather the misuse of tobacco, outside of its sacred, traditional use.

When misused, tobacco is a killer. Smoke it, chew it, snuff it and it will addict you! It will lead to cancer and it will kill you. It will kill you through many different cancers, such as lung cancer, but also through heart disease and lung disease.

Make no mistake: the misuse of tobacco products in a modern context such as cigarette smoking or chewing is a great evil that may kill 1 billion people on this planet in this century according to the World Health Organization.

The language in this blog is a little strong, but I feel this strongly about it.

It is my wish that not another lung choke, nor another heart fail, nor another living thing die from this addiction. And my wish for you, the smoker and tobacco user, is to know that it can be overcome. There is more support than ever! You can access free counselling by text, phone or email as well as information to help you quit at QuitNow.ca.

If you are a smoker, encourage your children to never start using tobacco.

It is hard, yes. But you can do it! All British Columbians can access free nicotine patches or nicotine gum through the BC Smoking Cessation Program.

Jim Coyle

About Jim Coyle

Jim is a tobacco reduction coordinator with the men’s health program, and has a background in psychiatry and care of the elderly. In former times, Jim was director of care at Simon Fraser Lodge and clinical coordinator at the Brain Injury Group. He came to Canada from Glasgow, Scotland 20 years ago and, when not at work, Jim plays in the band Out of Alba and spends time with his family.

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Tales from the Man Cave: Lung disease can suck the life out of you

Image of oxygen tank in front of a snowy background

Winter’s cold temperatures can make living with lung disease even harder. Jim knows the feeling and shares 13 tips to prevent exacerbations and improve lung health this winter.

People with chronic obstructive lung disease and asthma tend to have more episodes of worsening during winter months. So, with periods of deep freezing common during this time of year in northern B.C., it was suggested that I write about winter lung health. Having been diagnosed with emphysema for the last 20 years, it is a subject in which I am well versed!

The truth of the matter is this: when you can’t breathe properly, nothing else matters and a winter worsening of symptoms can see a person go from mild discomfort to all out panic and depression. For everybody who knows what that feels like, you know that it is an experience that can’t be put into words. This is why it is so important to ask: As winter kicks into high gear, what can those of us with lung disease do to try and avoid those exacerbations?

Here’s my short list of tips for winter lung health:

  1. We know that smoking is the worst thing that a person with chronic lung disease or asthma can do. I should not really have to say that but there are folks who have terrible difficulties quitting. To them, my advice is this: don’t feel guilty, just stop again and again and again. The carbon monoxide from cigarettes is robbing you of precious oxygen. I feel your pain, but stop and keep stopping if you have to. Look for supports to help you stop smoking, like nicotine replacement therapy. Visit quitnow.ca for great resources too.
  2. Watch your symptoms. If you’re asthmatic, you need to keep an eye on your peak flow meter. Make sure that you are taking any long-acting medication as prescribed and discussed with your doctor. Even if you are feeling OK, carry a rescue puffer with you.
  3. Air quality. Sometimes this is poorer in the winter so get into the habit of watching your local weather channel air quality report or visit bcairquality.ca, especially if you are carrying out any outdoor activity.
  4. Look out for those little increases in breathing difficulty during normal effort or slight exertion.
  5. Watch for an increase in cough or sputum. If it does not improve, see your doctor as soon as possible.
  6. Keep a thermometre in the house so that you can check if you are getting a fever.
  7. If you have chronic bronchitis, you will no doubt have an antibiotic on hand just in case of an attack. Don’t be afraid to use it and make an appointment with your doctor as soon as you do. If the intensity of the attack is unusual or feels really bad, don’t be afraid to go to your local emergency department. Better safe than sorry!
  8. If you have home oxygen, you should use it as prescribed by your doctor, especially during increased activity. By using your home oxygen, you are using less effort to get that necessary oxygen and important rest. Don’t smoke with your home oxygen tank on – it can catch on fire and there are several cases of this happening every year throughout the province.
  9. During winter months, some folks with COPD and asthma have a reaction to the cold. There are proprietary masks out there if you want to look for them but you should use at least a scarf to cover your mouth and nose when out in the cold if you can tolerate that.
  10. You can’t always avoid perfumes or smoke or other noxious smells that can trigger an attack but if you sense those around you, get out of that environment as quickly as you can.
  11. Keep as active as you can. One thing to watch is the buildup of body temperature when engaged in activities such as exercise or walking outside. It can creep up on you and really make you breathless all of a sudden, especially if you’re wrapped up against the cold. Find your tolerance and carry out those tasks in smaller bites to suit the disease you have.
  12. Eat a diet that’s full of nutritious food. Depending on how progressed your lung disease is, if eating makes you feel uncomfortable, you might have to have smaller, more frequent nutritious meals. If you are losing weight you should consult a doctor and dietitian.
  13. Learn to breathe. I know it’s something we do naturally and that we have no choice in the matter but with lung disease, we can start to develop a habit of breathing in a shallow fashion. For this, there is good advice all over the web (like at HealthLinkBC) but one way that can be doubly beneficial is to practice a relaxation-based technique such as yoga or meditation breathing. Learning to control your breathing might help to stop a panic in its tracks, even during a worsening of symptoms.

Winter can be a tough time for people with lung disease but we can still live a full life and, with the right preparations and precautions, even learn to push the envelope a little. I wish you well this winter.

For more information, visit:

Jim Coyle

About Jim Coyle

Jim is a tobacco reduction coordinator with the men’s health program, and has a background in psychiatry and care of the elderly. In former times, Jim was director of care at Simon Fraser Lodge and clinical coordinator at the Brain Injury Group. He came to Canada from Glasgow, Scotland 20 years ago and, when not at work, Jim plays in the band Out of Alba and spends time with his family.

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