Chapter 7: Respiratory System

Background

Respiratory illnesses such as COVID-19 and chronic respiratory diseases continue to be underestimated population health challenges. Both remain among the top 6 causes of death for Canadians (Statistics Canada, 2023). Respiratory health promotion and disease prevention are extremely important in both community and acute care settings.

The Social Determinants of Health in Relation to Respiratory Health

COVID-19

• In their systematic review, Green et al. (2021) found that racialized people, socioeconomically disadvantaged people, and women were disproportionately affected by the COVID-19 pandemic. Green et al. (2021) stated that racialized and low-income populations suffered greater mortality rates during the pandemic and women experienced increased rates of intimate partner violence during periods of lockdown. They found there was a direct correlation between the social determinants of health and the outcomes for adults during the pandemic (Green et al., 2021). The COVID-19 pandemic exacerbated the already alarming rate of health inequalities and has acted as a wake-up call for governments and public health professionals (Green et al., 2021).
•  COVID-19 disproportionately affected Black communities, which had higher infection and mortality rates and lower vaccination rates (Abrams et al., 2022). A quantitative study by Dalsania et al. (2022) gathered COVID-19 mortality statistics throughout the United States and found that the rates of mortality were higher in counties with a higher percentage of Black residents. The study also found that the social determinants of health were a driving factor in these increased rates (Dalsania et al., 2022).
• In their systematic review, Abrams et al. (2022) found that the COVID-19 affected the physical (respiratory and systemic) health of individuals globally. It also had the following adverse social effects on the pediatric population:
  • increased homelessness and housing insecurity
  •  increased food insecurity
  • reduced familial income
  • reduced quality of education
  • increased abuse and mistreatment
  • systemic racism

Chronic Obstructive Pulmonary Disease

• Risk factors for chronic obstructive pulmonary disease (COPD) include smoking, genetic predisposition, infections, malnutrition, aging, occupational exposures, air pollutants, asthma, and low socioeconomic status (Safiri et al., 2022). Many of these risk factors are directly related to the social determinants of health. Individuals with COPD may also experience a poorer prognosis if they have other diseases such as cancer, COVID-19, cardiovascular diseases, gastrointestinal disorder, musculoskeletal disorders, and mental health conditions (Safiri et al., 2022).
• In their cross-sectional study, Lee et al. (2023) discovered that communities with socioeconomic struggles such as poverty, unemployment, lower income, and less education experienced higher mortality of respiratory diseases further reinforcing the impact of the social determinants of health on overall health.
• Assari and Najand (2022) found that Black individuals developed chronic respiratory diseases such as asthma, bronchitis, emphysema, and COPD at all ages, whereas White individuals were more likely to develop these diseases at a higher age.

Culturally Responsive Practice Points for Health Care Providers

• A study by Sjoding et al. (2020) revealed that Black patients had almost 3 times the frequency of hypoxemia that was not detected by the pulse oximetry machine as White patients. This means that the pulse oximeter, which is used for detecting oxygen saturation in the blood, is not as accurate for Black patients. This is concerning because HCPs regularly rely on the pulse oximeter for administering and titrating oxygen therapy. Falsely high readings place Black patients at a higher risk for hypoxemia (Sjoding et al., 2020). Lapum et al. (2023) suggested HCPs should look beyond the pulse oximeter and assess respiration rate and rhythm, auscultate lungs, and possibly advocate for an arterial blood gas draw depending on the patient’s overall status.
• HCPs in public health departments can continue to address health inequalities at the individual, practice, and community levels (Green et al., 2021).
• When patients are admitted to the hospital setting with respiratory diseases/disorders, it is imperative for HCPs to take the time to educate patients on respiratory health promotion and disease prevention strategies such as receiving immunizations, using good hygiene practices, washing hands, and using masks (CDC, 2024).
• HCPs should pay close attention to the admission histories of COPD patients. If a patient has a history of frequent hospitalizations, they may require additional community supports. Pahkale et al. (2022) stated that many hospital readmissions for COPD patients are due to the patients’ continued tobacco use. Many HCPs continue to only offer screening questions and referrals for smoking cessation, despite the overwhelming evidence of the effectiveness of pharmacotherapies for reducing and quitting tobacco smoking (Pahkale et al., 2022). Pahkale et al. (2022) argued that HCPs must manage tobacco dependence as the legitimate chronic disease that it is, and that smoking cessation treatment is as important as COPD treatment and care. HCPs can use this information to improve the smoking cessation care for COPD patients.

References

Abrams, E. M., Greenhawt, M., Shaker, M., Pinto, A. D., Sinha, I., & Singer, A. (2022). The COVID-19 pandemic: adverse effects on the social determinants of health in children and families. Annals of Allergy, Asthma & Immunology, 128(1), 19–25. https://doi.org/10.1016/j.anai.2021.10.022

Assari, S., Najand, B., & Ayoubian, A. (2022). Blacks’ diminished salience of age as a determinant of chronic obstructive respiratory disease. Hospital Practices and Research, 7(3), 90–96. DOI: 10.34172/hpr.2022.19

Centers for Disease Control and Prevention (2024). Preventing respiratory viruses. https://www.cdc.gov/respiratory-viruses/prevention/index.html

Dalsania, A. K., Fastiggi, M. J., Kahlam, A., Shah, R., Patel, K., Shiau, S., . . . & DallaPiazza, M. (2021). The relationship between social determinants of health and racial disparities in COVID-19 mortality. Journal of Racial and Ethnic Health Disparities, 1–8. https://doi.org/10.1007/s40615-020-00952-y

Green, H., Fernandez, R., & MacPhail, C. (2021). The social determinants of health and health outcomes among adults during the COVID‐19 pandemic: A systematic review. Public Health Nursing, 38(6), 942–952. https://doi.org/10.1111/phn.12959

Lapum, J. L., Prendergast, N., & Istanboulian, L. (2024). Anti-Racist approach to pulse oximetry: A nurse educator’s guide. Nurse Educator, 49(3), 171–172. DOI: 10.1097/NNE.0000000000001542

Lee, Y. C., Chang, K. Y., & Mirsaeidi, M. (2023). Association of county-degree social vulnerability with chronic respiratory disease mortality in the United States. Annals of the American Thoracic Society, 20(1), 47–57. https://doi.org/10.1513/AnnalsATS.202202-136OC

Pakhale, S., Huynh, N., & Tariq, S. (2022). COPD Readmission: The missing link. The American Journal of Medicine, 135(10), 1147–1149. https://doi.org/10.1016/j.amjmed.2022.06.001

Safiri, S., Carson-Chahhoud, K., Noori, M., Nejadghaderi, S. A., Sullman, M. J., Heris, J. A., Ansarin, K., Mansournia, M. A., Collins, G. S., Kolanhi, A. A., & Kaufman, J. S. (2022). Burden of chronic obstructive pulmonary disease and its attributable risk factors in 204 countries and territories, 1990-2019: results from the Global Burden of Disease Study 2019. BMJ, 378. https://doi.org/10.1136/bmj-2021-069679

Sjoding, M. W., Dickson, R. P., Iwashyna, T. J., Gay, S. E., & Valley, T. S. (2020). Racial bias in pulse oximetry measurement. New England Journal of Medicine, 383(25), 2477–2478. DOI: 10.1056/NEJMc2029240

Statistics Canada. (2023, November 27). Table 1: Top 10 leading causes of death (2019 to 2022). https://www150.statcan.gc.ca/n1/daily-quotidien/231127/t001b-eng.htm