Bayis Ilh Tus - A Strong Breath: Prevalence and Contributors to COPD in First Nations Communities in British Columbia (ASB)

Bayis Ilh Tus - A Strong Breath: Community-Based Research to Identify the Prevalence of and Contributors to Chronic Obstructive Pulmonary Disease in Remote and Rural First Nations Communities in British Columbia

Background. First Nations peoples in Canada carry an increased respiratory health burden compared to non-First Nations. However, there is little accurate information of how many First Nations people have COPD, especially in remote and rural areas.

Goal & Aims of the Study. The goal of this study is to estimate the burden of COPD in remote and rural First Nations communities. This project is a partnership between the University of British Columbia (UBC), Carrier Sekani Family Services (CSFS), and 13 First Nations communities in northern BC.

Aim 1: Estimate the prevalence of COPD and the magnitude of underdiagnosis. Aim 2: Characterize the relationship between inhaled pollutants (from residential, occupational, and community/cultural sources) and: 1) symptoms; 2) airflow obstruction; and 3) health care utilization.

Methodology. The investigators will recruit adults from randomly-selected households in 13 First Nations communities in northern BC. Detailed measurements of lung function, symptoms, self-reported exposure to lung irritants, air quality, and healthcare use will be collected.

Expected Outcomes. This study will provide an accurate estimate of the prevalence of COPD and, using a culturally-relevant community-based research approach, will identify the contribution of risk factors to COPD in First Nations communities.

Study Overview

• Status: Recruiting
• Conditions: Pulmonary Disease, Chronic Obstructive

Detailed Description

Background. First Nations peoples in Canada carry an increased respiratory health burden compared to non-First Nations. They are often exposed to high rates of indoor air pollution and cigarette smoke; and although there is a high use of acute health care services for chronic obstructive pulmonary disease (COPD), this disease is not "on the radar" in many First Nations communities. This may be because there is little accurate information of how many First Nations people have COPD, especially in remote and rural areas. The current estimates of prevalence of COPD in First Nations are based on self-report surveys, which are known to underestimate the true number threefold. Although it is well-known that cigarette smoking causes COPD, there has been less attention paid to the contribution of residential, historical/community/cultural, and occupational factors to the burden of COPD in First Nations people.

Goal & Aims of the Study. The goal of this study is to estimate the burden of COPD in remote and rural First Nations communities. This project is a partnership between the University of British Columbia (UBC), Carrier Sekani Family Services (CSFS), and 13 First Nations communities in northern BC.

Aim 1: Estimate the prevalence of COPD and the magnitude of underdiagnosis. Aim 2: Characterize the relationship between inhaled pollutants (from residential, occupational, and community/cultural sources) and: 1) symptoms; 2) airflow obstruction; and; 3) health care utilization.

The Primary Outcome is the prevalence of COPD.

Methodology. The investigators will recruit adults from randomly-selected households in 13 First Nations communities in northern BC. The investigators will collect detailed measurements of lung function, symptoms, self-reported exposure to lung irritants, and healthcare use. The investigators will also collect indoor air quality measures from homes and community buildings. For Aim 1, the prevalence and underdiagnosis of COPD will be estimated by measuring lung function using post-bronchodilator spirometry and comparing the presence of airflow obstruction with the diagnosis of COPD in the electronic health record. For Aim 2, the investigators will explore the relationship between inhaled indoor air pollutants and 1) current cough, wheeze, and dyspnea; 2) airflow obstruction; and 3) respiratory-related primary care visits or hospitalization, adjusting for age, sex, and smoking history.

Expected Outcomes. This study will provide an accurate estimate of the prevalence of COPD and, using a culturally-relevant community-based research approach, will identify the contribution of risk factors to COPD in First Nations communities. The Primary Outcome is the prevalence of COPD.

Significance of this Project. This project is a novel partnership between UBC, CSFS and partner Nations to explore the prevalence and risk factors of COPD, using a Indigenous approach to health research. This study is unique in being able to address the risks of COPD in remote and rural First Nations communities, which will lead to further work to identify strategies to reduce these risks and improve lung health.

• Study Type: Observational
• Enrollment (Estimated): 325

Contacts and Locations

• Study Contact: Name: Pat G Camp, PhD; Phone Number: 604-806-9144; Email: pat.camp@hli.ubc.ca
• Study Contact Backup: Name: Travis Holyk, PhD; Phone Number: 250-562-3591; Email: travis@csfs.org

Study Locations

• Canada
  • British Columbia
    • Prince George, British Columbia, Canada, V2K5S3
      • Recruiting
      • 13 individual First Nations in north-Central BC near Prince George, BC
      • Contact: Travis Holyk, PhD; Phone Number: 250-962-5210; Email: travis@csfs.org
      • Contact: Benna Rathburn; Phone Number: 250-962-5210; Email: benna@csfs.org

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 26 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

We will recruit members of the participating First Nations communities, aged 30 years and older.

Description

Inclusion Criteria:

• 30 years and older
• living in one of participating First Nations communities

Exclusion Criteria:

• confusion, dementia

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort
Randomly-Sampled; Adults aged 30+ living in one of the First Nations communities whose household was randomly-sampled.
Walk-in Volunteers; Adults aged 30+ living in one of the First Nations communities who is a walk-in study volunteer, not randomly-sampled.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
forced expiratory volume, 1st second in litres	pre- and post-bronchodilator FEV1 to determine reversibility of airflow obstruction	measured at study recruitment
forced vital capacity in litres	pre- and post-bronchodilator measures of vital capacity for use in the diagnosis of COPD	measured at study recruitment
FEV1/FVC ratio	pre- and post-bronchodilator measures of FEV1/FVC to confirm diagnosis of COPD (where the FEV1 to FVC <0.70)	measured at study recruitment

Collaborators and Investigators

• Sponsor: University of British Columbia
• Collaborators: Carrier Sekani Family Services
• Investigators: Principal Investigator: Pat G Camp, PhD, University of British Columbia; Study Director: Travis Holyk, PhD, Carrier Sekani Family Services

Publications and helpful links

General Publications

• Turner J, Holyk T, Bartlett K, Rathburn B, Karlen B, Ervin F, Wilson J, Camp PG. "Bayis Ilh Tus - a strong breath" a community-based research project to estimate the prevalence of chronic obstructive pulmonary disease in remote and rural first nations communities in Canada: research protocol. Int J Equity Health. 2020 Jul 24;19(1):123. doi: 10.1186/s12939-020-01240-1.

Study record dates

Study Major Dates

• Study Start (Actual): February 13, 2018
• Primary Completion (Estimated): March 31, 2026
• Study Completion (Estimated): March 31, 2026

Study Registration Dates

• First Submitted: September 24, 2019
• First Submitted That Met QC Criteria: September 24, 2019
• First Posted (Actual): September 26, 2019

Study Record Updates

• Last Update Posted (Estimated): January 19, 2024
• Last Update Submitted That Met QC Criteria: January 18, 2024
• Last Verified: January 1, 2024

More Information

Terms related to this study

• Keywords: Epidemiology; Risk Factors; Indigenous; First Nations; Community-based Research
• Additional Relevant MeSH Terms: Pathologic Processes; Respiratory Tract Diseases; Disease Attributes; Lung Diseases, Obstructive; Chronic Disease; Lung Diseases; Pulmonary Disease, Chronic Obstructive
• Other Study ID Numbers: ASB-2018

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: No IPD is approved.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No