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.)

Share

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.

Share