Choosing Wisely Through Primary Care

Let’s Clear the Air!
Campaign to raise awareness about proper breathing tests

Asthma is a chronic disease that affects people of all ages. In fact, almost 4 million Canadians have a label of asthma. Similarly, one in four Canadians over age 35 have been labelled with COPD. People who are diagnosed with asthma or COPD are usually prescribed inhalers.

But did you know that some people on inhalers do not actually have asthma or COPD? Studies show that more than 30% of Canadians diagnosed with asthma or COPD to not actually have the conditions when formally tested.

Puffers can be expensive – and more importantly – if a person don’t really have asthma/COPD, the true reason for her symptoms is not being addressed.

In a 2017, a study published in the Journal of the American Medical Association, tested 613 people from cities across Canada and the researchers found that one-third of those who had been told they had asthma actually didn’t. They also found that 79% of that group was on asthma medications - unnecessarily. Similarly, studies show that 31 to 44% of patients who received a clinical diagnosis of COPD did not actually have the condition when tested objectively and many of these were on treatment as well.

Both asthma and COPD should be confirmed with a breathing test, spirometry, before treatment begins. Yet only 43% of Canadians with asthma and 36% of people with COPD have the test within a year of being diagnosed, leading to potential misdiagnosis and over-treatment.

The objective of Let’s Clear the Air Campaign is to raise awareness in both primary care clinicians and general public (who may have been diagnosed with asthma/COPD) about how undertesting can lead to overdiagnosis and over-treatment.

This initiative aims to encourage thoughtful conversations between clinicians and patients who have received a diagnosis of asthma or COPD to avoid unnecessary treatment and misdiagnosis that can occur without a proper breathing test.

World Asthma Day

World Asthma Day (May 3, 2022) is held each year to raise awareness about asthma worldwide. This year’s theme is Closing Gaps in Asthma Care.

On this day, we invite you to help spread the word about the importance of a proper breathing test to avoid unnecessary treatment or misdiagnosis in those with a diagnosis of asthma or COPD.

This campaign is led by Choosing Wisely Canada, the Member Interest Groups Section of the College of Family Physicians of Canada, the Canadian Thoracic Society and with the support from multiple health care organizations.

To help get these conversations started, the following resources have been developed.

ASSET	DOWNLOAD	Sample Messaging
General website		It’s #WorldAsthmaDay with a theme on closing gaps in asthma care. Learn about the importance of proper breathing tests to avoid unnecessary treatment or misdiagnosis in those with asthma and COPD. Let’s clear the air: https://bit.ly/cwc-airways
Patient Pamphlet – Asthma		Did you know that some people prescribed puffers do not actually have asthma? Learn about the importance of proper breathing tests to avoid unnecessary treatment or misdiagnosis. Let’s clear the air: https://bit.ly/asthma-airways
Patient Pamphlet – COPD		Did you know that some people prescribed puffers do not actually have COPD? Learn about the importance of proper breathing tests to avoid unnecessary treatment or misdiagnosis. Let’s clear the air: https://bit.ly/copd-airways
Animated Video Explainer		1 in 4 Canadians on puffers for asthma do not actually have asthma when formally tested. Every patient with suspected asthma should have a breathing test, called a spirometry test. Proper diagnosis will avoid unnecessary treatment. https://bit.ly/lets-clear-the-air

A timely e-course series on managing viral infections during the pandemic is available now!

A new four-part e-course on CFPCLearn helps family doctors educate patients about what’s appropriate and inappropriate for managing a viral infection during the fall and winter in the time of COVID-19. This e-course, developed in collaboration with Choosing Wisely Canada, covers both virtual and in-person care delivery.

Using Antibiotics Wisely: A Practical Approach to Managing Respiratory Tract Infections in the Era of COVID-19 and Virtual Care

Module 1: Influenza-like Illness, Bronchitis, and the Common Cold

Recognizing the criteria, considerations, and investigations associated with these respiratory tract infections that help determine the need for in-person assessment in the context of COVID-19.

Module 2: Acute Otitis Media

Focusing on acute otitis media, learners will be able to recognize the criteria, considerations, and associated investigations that will help determine the need for in-person assessment during COVID-19 as well as antibiotic choices.

Module 3: Pharyngitis

Looking at pharyngitis, learners will be able to recognize the criteria, considerations, and associated investigations to determine in-person assessment and antibiotic choices.

Module 4: Sinusitis

Looking at sinusitis and its criteria, considerations, and associated investigations in the context of COVID-19.

About CFPCLearn

The CFPC’s new learning platform has a wide range of Mainpro+^® certified professional development activities combined with the ease of direct credit entry. Earn up to 100 Mainpro+ credits. Register at https://cfpclearn.ca/.

Using Antibiotics Wisely

The Cold Standard 3.0 – A Toolkit for Using Antibiotics Wisely for the Management of Respiratory Tract Infections in Primary Care.

The Cold Standard 3.0

Using Antibiotics Wisely in Long Term Care poster and practice statements aim to reduce unnecessary antibiotic use for asymptomatic bacteriuria in LTC.

In response to members’ feedback, selected Using Antibiotics Wisely patient resources are now available in Punjabi, Simplified Chinese, and Spanish. Select a link below to download a PDF resource.

Antibiotics: Sorry

Antibiotics: Three questions to ask your health care provider

Antibiotics: Delayed Prescription

Disclaimer
The translation of selected Using Antibiotics Wisely patient resources into languages other than English and French represents a pilot initiative of the CFPC. The CFPC has attempted to ensure the original materials in English have been translated accurately; in the event that there is any inconsistency between the English and other translated versions, the English version shall prevail.

You can also integrate the Viral Prescription Pad and Delayed Prescription Pad in your existing EMR. The e-forms and accompanying instructions were co-developed by OntarioMD and Choosing Wisely Canada in collaboration. For any questions related to these materials, please contact [email protected].

Key Practice Statements

Time to Talk: Encouraging serious illness conversations

Choosing Wisely Canada is proud to partner with over 30 national clinician societies on a recommendation to encourage serious illness conversations. The recommendation, released on March 10, 2021, underscores the importance of earlier and better conversations about values, goals, and wishes to ensure patients receive the care they want, feel less distress, and avoid tests or treatments that are potentially harmful.

The College of Family Physicians of Canada supports the following recommendation and encourages our members to have these important conversations:

Don’t offer tests or treatments without establishing your patient’s prognosis, preferences, and goals of care. Potentially harmful or overly aggressive tests or treatments can be avoided by having discussions about goals and wishes, and documenting this information.

Early conversations about disease understanding, wishes and goals with patients who have serious or progressive chronic illness can avoid potentially harmful tests or treatments. Ensuring patients discuss and document wishes and goals, as well as identify a substitute decision maker can support evidenceinformed and patient centred care.

How you can get these conversations started:

Choosing Wisely Canada has developed tools and resources to help get these conversations started. You
can download below:

Interested in presenting on serious illness conversations? Download the Time to Talk presentation template:

Time to Talk – Presentation Slides

To learn more about these efforts, visit Choosing Wisely Canada’s website: www.ChoosingWiselyCanada.org/Serious-Illness-Conversations.

Opioid Wisely

Opioid Wisely office poster
Updated family medicine recommendations: Thirteen Things Physicians and Patients Should Question (opioid-specific recommendations)

For additional information please visit our project website.

Do More Screening Tests Lead to Better Health?

Whiteboard video

This 10-minute educational video focuses on a number of common screening tests (vitamin D malabsorption, mammography, thyroid testing, etc.) to help inform dialogue between family physicians and their patients on appropriate testing.

Combined Infographics

Questions?

Please contact Lily Oeur, Manager, Practice Support Programs at [email protected].