Prevalence and burden of obstructive lung disease in the urban poor population of Ottawa, Canada: a community-based mixed-method, observational study

Abstract

Background Globally the burden of Obstructive Lung Diseases (OLD) is growing, however its effect on urban poor populations with the high prevalence of tobacco dependence is virtually unknown. The purpose of this project is to estimate the prevalence and burden of OLD in the urban, low-income populations of Ottawa, Canada. Methods The study presented in this paper was part of the PROMPT (Management and Point-of-Care for Tobacco Dependence) project; a prospective cohort study in a community-based setting (n = 80) with meaningful Patient Engagement from design to dissemination. Spirometry data, standardized questionnaires and semi-structured interviews from PROMPT were interpreted to understand the lung function, disease burden and social determinants (respectively) in this population. Results The prevalence of OLD among those who completed spirometry (N = 64) was 45–59%. Generic and disease-specific quality of life was generally poor in all PROMPT participants, even those without OLD, highlighting the higher disease burden this vulnerable population faces. Quality of life was impacted by two major themes, including i) socioeconomic status and stress and ii) social networks and related experiences of trauma. Conclusion The prevalence and disease burden of OLD is significantly higher in Ottawa’s urban poor population than what is observed in the general Canadian population who smoke, suggesting an etiological role of the social determinants of health. This urges the need for comprehensive care programs addressing up-stream factors leading to OLDs, including poor access and utilization of preventive healthcare addressing the social determinants of health. Trial registration ClinicalTrails.gov - NCT03626064, Retrospective registered: August 2018.

Lung disease burden assessment by oscillometry in a systematically disadvantaged urban population experiencing homelessness or at-risk for homelessness in Ottawa, Canada from a prospective observational study

“…To be eligible, participants had been (1) currently living in Ottawa for at least 3 months, (2) been 16 years or older, (3) have been using street drugs (other than recreational marijuana or alcohol) in the past year, and (4) have smoked tobacco in the past 7 days. Full study details of CBPAR approach have been reported in previous PROMPT publications [28][29][30]. Briefly, all participants were provided a 6-month community-based intervention to reduce tobacco smoking and improve overall quality of life.…”

“…Participants who consented and were physically able underwent pre-and post-bronchodilator hand-held spirometry, oscillometry measurements (R 5-20 , a presumed measure of small airway resistance that increases in OLD; A x , a measure of the area under the reactance curve that increases in OLD; and X 5 , a measure of the elastic properties of the airway that worsens (becomes more negative) in OLD [33]) and an expired carbon monoxide test at baseline and at the final 6-month follow up. Spirometry data collection methods and analysis are reported in two previous publications [28,34]. Individuals were labelled with COPD based on spirometry using both the fixed ratio method (a post-bronchodilator FEV 1 / FVC ratio < 0.70) and the LLN (a post-bronchodilator FEV 1 /FVC ratio ≤ LLN).…”

“…Despite the potential widespread application of oscillometry, its use is limited by the paucity of data regarding reference values for oscillometry parameters. Those that do exist [25][26][27][28][29] are derived from small-scale studies consisting of mainly healthy Caucasians who do not smoke, without a personal history of lung disease [26,27]. The use of oscillometry in people in urban settings who identify as experiencing homelessness or being atrisk for homelessness, is non-existent, despite a disproportionately higher prevalence of OLDs and associated symptom burden in this population related to disproportionately higher prevalence of addictions (including tobacco) as compared to the general population [28].…”

“…Those that do exist [25][26][27][28][29] are derived from small-scale studies consisting of mainly healthy Caucasians who do not smoke, without a personal history of lung disease [26,27]. The use of oscillometry in people in urban settings who identify as experiencing homelessness or being atrisk for homelessness, is non-existent, despite a disproportionately higher prevalence of OLDs and associated symptom burden in this population related to disproportionately higher prevalence of addictions (including tobacco) as compared to the general population [28]. Therefore, there is a need for studies to assess the role of oscillometry in measuring lung function and disease burden in this systematically disadvantaged population.…”

“…In this study, we assessed obstructive lung disease (diagnosed by hand-held spirometry) and symptom burden using oscillometry in people who self-identify as experiencing homelessness or at-risk homelessness in downtown Ottawa. We compared the oscillometry values to spirometry values and to patients' self-reported symptoms [28]. We hypothesized that oscillometry values would correlate with spirometry values and that oscillometry values would vary based on patients' symptom burden of OLD, such as COPD.…”