Respiratory Care

Respiratory Care LogoThe goal of this program is to support people diagnosed with respiratory conditions and counsel those wishing to stop smoking.  Services include smoking cessation counselling, respiratory education (i.e. assessment of disease control, development of action plans & medication review & treatment) and point of care spirometry testing.

Patients living with asthma or chronic obstructive pulmonary disease (COPD) would benefit from a primary care referral to the Respiratory Care Program.

CLINICIANS

Pharmacist/Registered Nurses/Physician Assistant: Perform spirometry training after successfully completing a recognized spirometry training course.  Our preferred training is Spiro Trec offered by the Canadian Lung Association.

Pharmacist/Registered Nurses:  Perform smoking cessation counselling and prescribe/dispense nicotine replacement therapy after successfully completing Smoking Cessation Training with the Centre for Addiction & Mental Health (3 day Teach Course).

 

 

Who should be tested for COPD?

Spirometry testing should be performed on all current and former smokers, 40 years of age and older, who show respiratory symptoms (e.g. shortness of breath, cough with or without phlegm, wheezing, frequent long-lasting colds, and difficulty keeping up with daily activities such as walking).

With early diagnosis and proper treatment, people with COPD can experience improved exercise tolerance, less hospitalizations related to breathing difficulties and an improved quality of life.

What are the complications of having COPD?

People with COPD can experience frequent flare-ups brought on by a cold or the flu, change in weather or poor air quality. This can result in emergency room visits, hospitalizations and sometimes death.

What causes COPD?

Chronic Obstructive Pulmonary Disease (COPD), includes two major lung diseases: emphysema and chronic bronchitis. Smoking is the main cause of COPD. Cigarette smoke narrows the airways and causes chronic swelling in the lungs, which make it difficult to breathe.

Why do I have to keep taking my asthma medications if I feel fine?

Many asthma medications only work if you take them daily (or sometimes, twice a day). Your controller inhalers work by keeping your airways open, so that they are less reactive to triggers. If you stop taking them, your airways will narrow and become more reactive to allergens or your asthma triggers.

Asthma medications are generally very safe – your health care provider picks the lowest dose needed to keep your asthma well controlled.

One of the most common medications used to treat asthma are inhaled steroids. There are many misconceptions about inhaled steroids, however, they are safe, provide great long-term benefits and are prescribed in safe doses.

Why does asthma make it hard to breathe sometimes?

Asthma affects the airways in the lungs, which carry oxygen to the rest of your body. When asthma is not well controlled, the airways narrow, which makes it harder to get air into and out of the lungs.

How do I prepare for spirometry?

We ask that you:

  • Don’t smoke at least 1 hour before the test
  • Don’t drink alcohol within four hours of the test
  • Avoid vigorous exercise before the test
  • Wear loose or comfortable clothing
  • Don’t eat a large meal before the test

Your health care provider will tell you if you should take your daily inhalers prior to the test. However, we ask that you always hold your fast acting bronchodilator (e.g. Ventolin - the “blue puffer”) for at least 4 hours before the test, unless you are in distress.

When should spirometry be avoided?

Spirometry needs full cooperation and effort from the patient to get accurate results. The patient needs to be at least 6 years of age.
We cannot perform spirometry if you have had:

  • Recent heart attack or stroke (within the past 6 weeks)
  • Eye surgery in the past 2 weeks
  • Recent abdominal or thoracic surgery (within the past 6 weeks)
  • A history of an aneurysm
Is spirometry only for patients with Asthma or COPD?

No, spirometry is used to assess patients with symptoms of lung disease (e.g. cough, shortness of breath, wheezing, frequent chest infections), to assess people at risk for lung disease, those with a family history of lung disease or to monitor people exposed to harmful agents (e.g. occupational exposure). Spirometry can also be used for insurance or legal purposes.

Spirometry is helpful for people with Asthma or COPD, as it allows us to make an accurate diagnosis, obtain a baseline, monitor effectiveness of treatment and make changes to therapy based on the results.

What if I can’t afford smoking cessation medications?

Taddle Creek FHT patients can receive free counselling with one of our smoking cessation experts.

We have also partnered with CAMH in a program called STOP-FHT (Smoking Treatment for Ontario Patients in Family Health Teams).  If you enrol in the STOP-FHT study, along with counselling, we can provide you with up to six months worth of Nicotine Replacement Therapy (Patch, Gum, Lozenge, or Inhaler) free of charge.  (Note, we can only dispense up to 4 weeks at a time).

Ontario Drug Benefit (including ODSP) also covers up to 12 weeks of Zyban and/or Champix per year.

What can I do to eat healthy and minimize weight gain (while trying to stop smoking)?

Eat the same amount of food as before.
Eat smaller portions more frequently.
Drink lots of water.
Eat low-fat snacks like veggies and fruits.
Be as active as possible.

I’ve used Nicotine Replacement Therapy (NRT) in the past and it didn’t work.

There are many reasons why this could be true and just because it didn't work before doesn't mean it won't work in the future.  The most common reason for NRT failure is under-dosing (not getting enough).  For example, a heavy smoker (over a pack a day), usually uses more nicotine per day than even the strongest NRT patch provides.  Therefore, it is quite likely to have more severe withdrawal symptoms and cravings despite being on the patch which leads people to believe it didn't work.  There are strategies to increase your NRT dose such as using combination therapy (NRT Patch + Gum/Lozenge/Inhaler/Mouth Spray) or slowly increasing your NRT patch dose by using more than one patch.  Our smoking cessation experts can help you choose a safe strategy that works for you and provide guidance with choosing the correct dose of NRT.

Can I smoke while I’m on Nicotine Replacement Therapy (NRT)?

Yes, if you are reducing the number of cigarettes you smoke each day, then you can make up for it with NRT.  This strategy is sometimes called "reducing-to-quit".  It is especially helpful for people who require more time to quit smoking completely but want to start reducing their smoking right away.  For example, you can skip one cigarette and use a piece of nicotine gum instead.  Another example could be reducing from 20 cigarettes per day to 10 cigarettes per day and wearing a nicotine patch.  Our smoking cessation experts can help you choose a safe strategy that works for you and provide guidance with choosing the correct dose of NRT.

Why is Nicotine Replacement Therapy (NRT) helpful and will it affect my overall health?

Each cigarette you smoke has over 4000 chemicals and over 200 known carcinogens (cancer causing agents).  Nicotine Replacement Therapy (e.g. Patch, Gum, Lozenge, Inhaler, and Mouth Spray) is a "clean" version of nicotine and has little negative affect on your health compared to smoking.  Therefore, using NRT, even for extended periods of time, is considered a harm reduction.  NRT works by providing your body with nicotine while you stop or reduce your cigarettes.  This helps to reduce and manage any cravings or withdrawal symptoms while you are quitting.  When you are ready, you can gradually taper off the NRT.

Besides medications, what else can I do to help me quit smoking?

There are many things you can do to help get prepared to quit!

  • Set a quit date and mark it on your calendar.
  • Talk about it with family and friends; elicit their support.
  • Make a list of your reasons for quitting.  Refer back to it if you're wavering.
  • Keep a smoking diary to help identify your reasons for smoking.  Then think about what you can do to avoid smoking for each situation. (E.g. stress, boredom, coffee, social, waking up in the morning, driving, etc.)
  • Assess your environment: Make your home and car smoke free.  Avoid the smoking section at work. Remove ashtrays and other smoking paraphernalia.
  • Manage your stress in positive ways. For example, exercise, getting enough sleep, relaxation, and meditation.
  • The 4 D's: Delay, Distract, Drink water, and Deep breathing.
  • Plan to eat healthy snacks.
  • Cut down on your coffee/caffeine intake when you quit, especially if you drink more than 2 cups of coffee per day.
  • Cut down on alcohol if you smoke more when you drink.
I want to quit on my own, without medications, is this class still for me?

Many people choose to quit without the help of medications and many are successful.  The Quit Happens class is a general overview of the medications used to quit, non-drug lifestyle strategies, and the services we offer at Taddle Creek Family Health Team.  Regardless of whether you use a medication to help you quit smoking, our skilled smoking cessation team also provides counselling services to support you in your quit attempt.  In fact, research suggests that attending a smoking cessation program actually doubles your chances of quitting smoking.