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Clearing the air

By Alisa Kim  •  September 30, 2016

From her second-floor office at the Institute of Clinical Evaluative Sciences on the campus of Sunnybrook Health Sciences Centre in Toronto, Canada, Dr. Andrea Gershon rattles off statistics about chronic obstructive pulmonary disease (COPD), a lung disease that worsens over time: COPD is the number three killer worldwide, and a leading cause of hospital admission and readmission in Canada; one in four adults over the age of 35 has been diagnosed with it.

“It’s a very serious, disabling condition that puts a large burden on society, not just directly, but I think everybody has a relative or friend or someone they know that has COPD,” says Gershon, who is a scientist at Sunnybrook Research Institute and a respirologist at Sunnybrook.

Yet for all the lives it disrupts, the disease, in which damage to the lungs makes breathing difficult, has been relatively ignored by health care administrators and policy makers, says Gershon. This is startling considering the social and economic toll of the disease; a Canadian study estimates the total cost of COPD hospitalizations at $1.5 billion per year. More recently, however, hospitals and policymakers “are starting to realize that COPD is a problem and are directing more resources to it,” she says.

A case in point: Gershon received an Early Researcher Award from the Ontario Ministry of Research, Innovation and Science to support her work, which aims to improve quality of care for people with COPD in Ontario. The award, worth $100,000, helps new researchers build their teams. She notes the investment will build capacity in respiratory research.

Her team is doing a systematic review of research on COPD care to assess and validate quality indicators. These are ways of measuring the effectiveness of COPD care. They include whether people receive breathing tests, also known as spirometry; if they see a specialist; and how often they have to go to a hospital. “All these measures let us know how people with COPD are being cared for, and where the gaps in management are,” says Gershon. “There are a lot of evidence-based management practices that we know help people with COPD, but not everybody’s getting them.”

The researchers will also look at the health records of people in Ontario with COPD to determine whether the quality indicators that the team developed are associated with improved outcomes. “We can look at these people and learn from their real-life experiences, which is very powerful. We can also use their data to confirm the effectiveness of clinical practices that may not have a lot of evidence behind them,” says Gershon.

Next, the researchers will measure the calibre of COPD care in Ontario using the validated quality indicators. They will also study the quality indicators in groups that are at risk of receiving substandard care, including women, people aged 65 and older, and those of low income.

This research is important given that COPD exerts a large socioeconomic burden. Statistics Canada indicates more than 800,000 Canadians contend with the disease. Moreover, if you visit an emergency room on any given day you’ll find it populated by people with COPD, notes Gershon.

Another barrier to improving treatment of this debilitating condition is the stigma associated with it. Gershon says it is perceived as a disease of smokers and that in her experience, even patients feel they “deserve” it. She also notes that COPD occurs in people who’ve quit smoking and those exposed to second-hand smoke. Things are turning around, however, thanks to more awareness. “The more we can recognize and address it, and help these people, the better off we all are,” says Gershon.