Faculty of Pharmaceutical Sciences



Lung Health – Educational and Preventative Health EventParticipant GuideIntroductionPharmacists are well-positioned to provide education and preventive health initiatives for the benefit of patients and the public.This guide describes a Lung Health service that has been successfully prototyped by pharmacy students and pharmacists at the UBC Pharmacists Clinic. The clinical and procedural materials have been modified to enable any pharmacist to provide a similar service using equipment and materials routinely available in a community pharmacy.The service includes the following components:Information on the structure and function of the lungsMeasurements of lung function: Respiratory rate and pattern, and peak expiratory flowInformation on factors that impact lung health and assessment of personal risk factorsA personalized plan for maintaining healthy lungs and managing lung conditions when present To ensure accountability and compliance with regulatory requirements, all health care services should be provided by licensed pharmacists, pharmacy students supervised by a licensed pharmacist or other regulated health care professionals. NOTE - This guide does not cover logistic and business aspects of organizing a health event such as: advertising, where to hold the event, identifying participants, booking appointments, charging fees, liability issues, offering service to local businesses, etc.About the Pharmacists ClinicThe Pharmacists Clinic, located?at the?UBC Faculty of Pharmaceutical?Sciences, is a university-affiliated, licensed, pharmacist-led patient care clinic with a mandate to:Be a model of patient care best-practicesProvide learning and skill development opportunities for health professionals?and studentsBe a living lab that contributes service models, systems, processes, research and program evaluation for the health care community.?More information about the Clinic is available here: ApproachParticipants are typically scheduled at 15 minute intervals with the total appointment time being about 20 minutes, although this may vary.Two options for service delivery are:Participants move from station to station and receive part of the service at each stationParticipants receive all services from one personIf enough pharmacists/students are available, 2 or 3 participants can receive service at the same time in parallel service streams.Participants receive a Lung Health Passport where information about their health is recorded and they will take home. NOTE – the pharmacy needs to also keep a record of service provided. This can be done using an excel spreadsheet, taking a copy of the completed passport or using an electronic record. The order of service is at your discretion, however, experience has shown that the following step-wise approach provides a logical flow. Station* (if used)Step in PassportService Description ARegister participant in pharmacy record and give passport1Complete the “About Me” sectionBExplain the structure and function of the lungsCheck height, weight, BMI, respiratory rate, breathing pattern, lung conditions and lung-related symptoms2-5Complete the “My Body”, “My Breathing”, My Lung Conditions” and My Symptoms sectionsC7Measure lung function (peak flow) 8Complete the “My Risk Factors” section 6Complete the “Current Medications” sectionD9Interpret results and establish “My Plan” with the patient10Pharmacist signs the passport *If service offered in stations, Station A can be manned by an administrative person. Stations B and C can be manned by pharmacy students with pharmacist supervision. Station D is for the licensed pharmacist.MaterialsIn addition to this Guide, materials provided for use at a Lung Health event are:Lung Health PassportImages (to print or load onto an iPad and have available at Station B)Clinical Resources (to have available at Stations C and D)Recommended list of supplies to have on-handPreparatory ReadingsClinical people (pharmacists/students) who will be providing service in the Lung Health event are encouraged to read the following materials so they are familiar with the elements of lung health being measured and discussed:1. Overview of lung anatomy and physiologyThe Lung Association – Respiratory System Lung Association – Breathing Animations of respiration: 2. Peak flow meter overview 3. Proper breathing techniques 4. ImmunizationInfluenza: : Delivery - Step-by-StepStation A “Welcome to our Lung Health event. You will be receiving information about your current health status and habits that impact on the overall health of your lungs. Information will be recorded in a passport for you to take with you. To start, we will record your name, year of birth, your gender and today’s date. Please proceed to the next station.” Station B “At this station, I will explain how lungs function, we will record information about you and your lung health and we will check the way you breathe. Do you have any questions before we start?”Discuss key messages:(use images and pictures to facilitate discussion and provide context)Your lungs have an important role in keeping you strong and wellMost people take their lungs for granted until they experience problems with breathing. The reality is, like the rest of our body, our lungs need daily care and attention.Lungs at rest and during most daily activities are working at only 50 percent of their capacity. This means we have some reserve if something goes wrong, but it also means we can have a serious lung disease, yet show no symptoms.Chronic lung disease is in fact the 4th leading cause of death in Canada (2014 StatsCan)The lungs are part of a complex apparatus, expanding and relaxing thousands of times each day to bring in oxygen into the body and expel carbon dioxide outReview diagram of respiratory system (you may elect to show an image for) tract componentFunctionPathology Airways (Trachea/windpipe, bronchi and bronchioles)Conduct airTrachea branches into bronchi, which in turn branch to become progressively smaller tubes throughout the lungs-Asthma (chronic airway inflammation)-COPD (inability to exhale normally)-Viral bronchitis -Allergies-Cystic fibrosis: Cannot clear mucus-Sleep apnea (often upper part of airway due to neck anatomy)Air sacs (Alveoli)At the end of the airways, involved in gas exchangePneumonia, influenza, TB, emphysema, lung cancerInterstitiumMicroscopically thin, delicate lining between the air sacs. Tiny blood vessels run through interstitium and allow gas exchange between alveoli and bloodInterstitial lung disease, pneumoniasBlood vesselsRanges from small ones in the interstitium to large ones that move blood both ways between the body and lungsPulmonary embolism, pulmonary hypertensionPleuraA thin lining of tissue surrounding lungs and inside the chest wall (rib cage). A tiny layer of fluid allows pleura on the lung’s surface to slide along the chest wall with each breathPleural effusion, pneumothorax, mesothelioma (post asbestos)Chest wallMuscles that connect ribs to each other and help chest expand and contract for breathingObesity: Extra weight on chest and abdomen hinders chest’s ability to expandNeuromusuclar disorders: paralysis, ALS, muscular dystrophiesDiaphragmA muscle between the lungs and abdomen that descends with each breath in, causing chest expansion to move air into and out of the lungsNeuromuscular disorders (Paralysis, ALS)Use videos to explain the physiology of breathing and gas exchange general information regarding the patient Measure height and weightCalculate BMI using any calculator (BMI = kg/m2). Check respiratory rate (RR) by watching and counting how many breaths a person takes in 10 or 15 seconds and then calculate the breaths/minute Pre-existing lung disease screenReview lung diseases checklist and Circle Y/N based on known conditions/diagnoses:AsthmaCOPDAllergies (environmental)Sleep apnea Lung infection in last 12 monthsOther (note manually on the passport)Specific questions about signs and symptoms that can indicate a problem with the lungs:Review symptom checklist and circle all that apply:Shortness of breathWheezinessPain with breathing Persistent coughVoice hoarsenessLoss of appetite/weight lossSnoringDaytime fatigueWaking up from sleep choking/gaspingMorning headaches “You are ready to move on to Station C where we will do a measure to assess lung capacity and ask about lifestyle factors and health conditions that can influence lung health. Then you will meet with the pharmacist for a consultation on your results.”Station C “At this station we are going to measure your lung capacity, assess lifestyle factors that contribute to life-long healthy lungs and briefly review any medications you are currently taking. Do you have any questions before we start?”Measure Peak expiratory flow Key messages:Peak flow measures your ability to push air out of your lungs in liters per minute. Lung conditions that cause airway damage or inflammation may affect this measurementA "normal" peak flow rate is based on a person's age, height, sex, race and physical health. Peak flow generally increases from childhood to adulthood, with height and is generally higher in males due to increased lung size. Caucasians typically have greater peak flows vs. other races.Directions for using Peak Flow Meter:Ensure a disposable mouthpiece is used for each patient and that the mouthpiece of the peak flow meter is sanitized with an alcohol swabStep 1: Before each use, shake the meter vertically to make sure the sliding yellow marker is at the bottom of the numbered scale Step 2: Have patient stand up straight (may sit if unable to stand). Remove gum or any food from mouth. Instruct them to take a deep breath (as deep as they can). Ask them to put the mouthpiece of the peak flow meter into their mouth forming a tight seal with their lips and ensuring tongue is away from the mouthpiece. In one breath, have them blow out as hard and as quickly as possible: “blow a fast, hard blast until you have emptied out nearly all of the air from your lungs”.Step 3: Note the PEFR in L/min in the Passport.Step 4: Repeat the entire routine three times. (You know you have done the routine correctly when the numbers from all three tries are very close together.)Step 5: Use their best reading as compared to expected value to determine where they fall (80-100%, 50-79%, <50%) and note in passport. Assessment of risk factors that can affect lung health Complete risk factor checklist: Smoking (current or recent) and pack year history Describe what smoking does to the lungs and the good news that no matter how long someone has smoked, the lungs can heal themselves when smoking stops “15 years post smoking” diagram Healthy lung vs. smoker’s lung pictureRisk factors for lung infections: Age≥65, chronic disease, weakened immunityOccupational/environmental exposures Sedentary (<30 min of physical activity - where the heart rate goes up and some sweat forms - most days/week)Obesity/overweight – BMI >24.9Note limitations of BMIChest breather or use of accessory muscles (as self identified during station 2)Immunization status Influenza (yearly)Pneumococcal Record medicationsCollect medication (Rx, OTC and NHP) information from the patient (what you take, why you take it, how you take it)“You are ready to move on to Station D where the pharmacist will go over all the information we’ve gathered, discuss your results and answer your questions.”Station D “At this station, we will review your measurement results, risk factors and go over any questions you have. We will then talk about a plan for you to maintain optimal lung health.”One of the following 3 approaches can be taken for this consultation, depending on the patient’s status. Alternatively, focus could be on smoking cessation if patient identifies as being ready to quit and is seeking information.Healthy lungs: all measurements normal, no risk factorsPositive reinforcement of lifestyle measures for optimal lung health (exercise, hydration, posture, healthy breathing, infection prevention)Review diaphragm or “belly” breathing using AHS pictogram (print out)Additional resource:Healthy Breathing Handout, adapted from: or pneumococcal vaccination assessmentIf patient is a smoker, assess readiness to quit and provide info regarding BC’s smoking cessation service and productsAsthma: Create asthma action plan, puffer techniques Materials: Placebo puffers, asthma action plan, BC Health Link on asthmaInfluenza or pneumococcal vaccination assessmentIf patient is a smoker, assess readiness to quit and provide info regarding BC’s smoking cessation service and productsCOPD: Create COPD action plan, puffer techniques Materials: Placebo puffers, COPD action plan, BC Health Link on COPDInfluenza or pneumococcal vaccination assessmentIf patient is a smoker, assess readiness to quit and provide info regarding BC’s smoking cessation service and productsDiscuss key messages:Emphasize ways to optimize lung healthEducate on meaning of Peak flow measurementsFinal steps:Document the plan in the passport “My Plan”If the participant has more questions, wants information on supplements or has issues for the pharmacist, suggest they follow-up at another time.If the participant has risk or issues that warrant a medical visit, ask them to follow-up with their family doctor or GPOccupational health and safety Suspected sleep apneaSpirometry Lung cancer screeningIndications for spirometry:Evaluation of symptoms such as chronic persistent cough, wheezing, dyspnea, and exertional cough or chest painObjective assessment of bronchodilator therapyEvaluation of effects of exposure to dusts or chemicals at workRisk evaluation of patients prior to thoracic or upper abdominal surgeryObjective assessment of impairment or disabilityMonitoring disease course and response to therapyIndications for lung CA screening (CTFPHC):Have a history of heavy smoking (30 pack years+, or 15 2pack years)Smoke now or have quit within the past 15 yearsAre between 50 and 74 years old“Thank you for participating in this event. We hope you found it useful. Do you have any feedback that we can use to make this event better in the future?“Make note of the feedback ................
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