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COPD/BreathWorks Spring 2017 Issue


Letters of Support for Bill 71, Lung Health Act, 2016
How Can I Help Support Bill 71?
COPD and the Spiral of Inactivity

RE: Support for Bill 71, Lung Health Act, 2016

Below this introduction, we have included some examples of letters sent to Members of Provincial Parliament written in support of Bill 71. Anyone can write a letter, whether you have a lung disease, care for someone with a lung disease, are a health-care professional who treats people with lung diseases, or are a member of the public.

Ottawa resident Carmela Graziani knows first-hand about the implications of lung disease – she has lived with severe asthma since her childhood. Here is her story and why she thinks Bill 71 is so important to us all.

Please note: This letter’s content is associated with the writer.

March 20, 2017

Dear Premier Wynne; Hon. Ministers Hoskins, Chiarelli, Lalonde and Naqvi; and MPPs Fraser, Des Rosiers, McMeekin, Yurek, and Gélinas:

I am writing to urge you to enact Bill 71, Lung Health Act, 2016 in order to:

  • Establish a Lung Health Advisory Council that will make recommendations to the Minister of Health and Long-Term Care on lung health issues;
  • Develop and implement an Ontario Lung Health Action Plan respecting research, prevention, diagnosis and treatment of lung disease;
  • Require the Minister of Health to consider the recommendations and reports of the Lung Health Advisory Council and to make improvements in lung health awareness, diagnosis, treatment and care.

I am a lifelong allergic asthmatic. I never smoked, but I was regularly exposed to second-hand smoke for 30 years, which also caused severe asthma attacks. I have encountered many barriers in the health care system. It took me many years to find the appropriate level of medical care and the specialists that I needed to help me manage my severe lung disease and health complications. As a result of these experiences, I wrote Breathing Easier – A Guide for Asthma and COPD Patients in the Champlain Region (first edition published in 2008 and second edition published in 2014). I created this lung health tool to educate patients, caregivers, and health care providers about lung disease, treatment plans, and clinical guidelines; and to help them navigate the regional health care system.

Too many physicians and recent medical school graduates are not properly educated and trained in asthma management, and do not follow the Canadian Thoracic Society’s Respiratory Guidelines or the international guidelines for asthma management under the Global Initiative for Asthma. Too often, primary care physicians prescribe asthma medications but do not send patients for lung function testing[1] and they do not refer patients to respirologists, and to respiratory education and rehabilitation programs.

It is time to raise the standard of care for lung patients in Ontario. This is a significant public health issue in the Champlain region where 10%[2] of all residents have asthma, and where 17% of 12- to 19-year-olds have asthma.[3] All individuals with lung disease, from premature babies to individuals receiving palliative care, in urban and rural regions of Ontario, need you to enact Bill 71 without delay.

We need to work together to:

  • Ensure that anyone prescribed lung medications undergoes spirometry testing.
  • Improve access to lung specialists, and to respiratory education and rehabilitation programs.
  • Improve the curriculum on lung disease in medical schools.
  • Improve the education and training of health care providers in the community, in emergency departments, and in hospitals.
  • Ensure that health care providers along the continuum of care are trained in, and following national and international clinical guidelines and clinical pathways.
  • Ensure that all emergency departments follow clinical guidelines and clinical pathways for the management of asthma in children, as many children do not have access to pediatric hospitals in their communities.
  • Decrease morbidity and mortality rates.
  • Improve lung patients’ quality of life.
  • Save taxpayers’ dollars.

Respectfully submitted,
Carmela Graziani


[1] Elizabeth Payne. It’s not just adults — children are also being overdiagnosed with asthma. The Ottawa Citizen. January 20, 2017.

[2] Libman, Bruce. Champlain Local Health Integration Network. Lung Health in Champlain: An Overview of Asthma and Chronic Obstructive Pulmonary Disease Prevalence and Health System Usage, page 10. August 2014.

[3] Ibid, page 2.

RE: Support for Bill 71, Lung Health Act, 2016

Here is another great example of a letter to support Bill 71, written by our Lung Health Ambassador from St. Catharines – Bev Black. Bev was told that because she smoked, she has no one but herself to blame for her COPD. Bev is reflecting on how and why she started smoking and why she thinks Bill 71 is important to all of us. Here is the letter that Bev sent to 108 Members of Provincial Parliament (MPPs).

Please note: This letter’s content is associated with the writer.

Dear Member,

One day in 2015, when I was at Queen’s Park advocating for support with respect to Private Members Bill 71 for Lung Health, one member said to me “Bev, you smoked. What did you expect?” That statement has resonated with me ever since.

It was 1964, when at age 22 I picked up my first cigarette. It was a different time and everybody smoked. Smoking was omnipresent. There wasn’t a place that you could go to where someone wasn’t smoking. It was in the workplace, in restaurants, at the movie theatre and even in the hospitals.  Smoking was a part of the culture and millions of people were not aware of the risks when they picked up that first cigarette. Thankfully, I quit smoking many years ago, but the damage was done. I am a COPD patient and the quality of my life, like millions of others, has been compromised.

Bill 71 will provide funding for research and treatment for lung health patients, as well as for the education programs. The Bill has passed two readings, yet has stalled since the second reading on 24th November 2016. I am disheartened as many people continue to live with serious lung health issues as I write this.

The government has collected millions in tax revenue from the sale of tobacco products.

I must ask you to look at this issue and ask yourself is it the stigma of the cigarette that is giving you pause?

I would like to offer the following for you to consider:

  • Kayla Kayla never smoked and tragically, Kayla lost her life at age 17 due to lung disease.
  • Madison Madison is my granddaughter. She has been raised in a smoke-free environment. When Madison was 18 months old, she was rushed to the

hospital unable to breathe.  A kind nurse gave my daughter an Aerochamber because they were not covered by insurance and cost $50 to $60 per unit. Children under 12 need these valuable devices to maximize the result when using puffers.

  • Mary and Emilia P. Mary and Emilia are two ladies who have never smoked, yet they are both suffering from lung health issues. They are both members of our lung health support group.

Do any of these names give you pause?

Our Private Members Bill 71 is ALL INCLUSIVE.  Bill 71 will help all people who are suffering from lung health issues. I pray you will do the research and realize the importance of Bill 71.  I am asking for your support on behalf of all who suffer from lung heath issues.

Sincerely, Bev Black

March 11, 2017

How Can I Help Support Bill 71?
A Provincial Lung Health Action Plan

Lung disease affects more than 2.8 million people in the province of Ontario and is the fourth leading cause of death in the world[1]. Unfortunately lung disease does not get the same attention as other chronic illnesses in Ontario.  Out of four chronic diseases responsible for 79% of all deaths in the province [2](cancers, cardiovascular diseases, lung disease and diabetes), only lung disease is without a dedicated, coordinated, province-wide effort to minimize the ever-increasing human and economic burden. 

It is estimated that lung disease currently costs Ontario taxpayers more than $4 billion a year in direct and indirect health care costs.

Without changes to the way the province addresses lung disease, the number of individuals living with asthma, COPD and lung cancer alone is expected to grow by 50% to an alarming 3.6 million in the next 30 years. [3]

The Lung Association – Ontario is stepping up advocacy efforts and bringing forward the much needed Lung Health Action Plan in the form of a revised Private Members’ Bill (PMB).  An original version of the bill was introduced by then Member of Provincial Parliament (MPP) Kathryn McGarry in 2014, but didn’t pass into law due to suspension of the Ontario Legislature in September 2016.

In November 2016, The Lung Association met with and found a new champion – Ted McMeekin, MPP for Ancaster-Dundas-Flamborough-Westdale; as well as MPP Jeff Yurek and MPP France Gelinas, forming support from all three political parties.

Together they all made a commitment to help those living and dealing with lung disease. Now we need your help.

This tripartite PMB calls for the establishment of a Lung Health Advisory Council and the development of a Lung Health Action Plan that will provide a coordinated approach on how lung disease is prevented and treated in our province.  The resulting Bill 71 and the proposed Ontario Lung Health Action Plan provides solutions from prevention through to early identification, treatment, policies and research.

In order to move the bill forward we need the commitment from patients, our readers, and the public in the form of supportive letters, emails and telephone calls to all Members of Provincial Parliament. As lung disease affects us all, be it through personal experience, economic impact, or the most significant impact of all – the long-term quality of life of individuals and families who are affected by lung disease – speaking out will make a difference.

Several lung health ambassadors have already written a personal letter in support for Bill 71 to their MPPs. With their permission we are publishing a copy of their letters in this newsletter, which includes their personal story and how lung disease has affected their lives and the lives of those close to them. Please read their letters for your interest and inspiration.

If you have any questions about writing your letter, such as what to write or to whom to send it, please contact:

Chris Yaccato, Provincial Manager, Government Relations and Public Affairs, The Lung Association – Ontario Tel: 416-864-9911 ext. 279     E-mail:


[1] World Health Organization

[2] Taking Action to Prevent Chronic Disease – Cancer Care Ontario

[3] “Your Lungs, Your Life: Insights and Solutions to Lung Health in Ontario, Ontario Lung Association, 2011.


COPD and the Spiral of Inactivity

People with chronic obstructive pulmonary disease (COPD) often get short of breath when they exercise. This can make it tempting to stop exercising. Yet regular exercise is one of the most powerful tools for managing COPD, along with quitting smoking and proper medications.

Here is how the downward “spiral of inactivity” happens:

  1. You get short of breath when you exercise, so you become less active.
  2. When you are less active, you become less fit and more short of breath.
  3. This increased shortness of breath in turn causes you to be even more inactive.

Staying active has many benefits for people with COPD. Other benefits include improved:

  • Heart health
  • Mood
  • Muscle strength
  • Quality of life

In some communities, pulmonary rehabilitation (PR) teaches people with lung disease many skills that can help to improve exercise tolerance, and to learn different ways to reduce breathlessness, fatigue and conserve energy. Some communities also offer an exercise maintenance program that allows people to continue exercising once the PR is finished. It is also a great way to be in touch with other people who also have lung disease.

To find out if there is a pulmonary rehabilitation program or an exercise maintenance program in your area, go to and enter you province/town OR your postal code.

You can also check out the exercise maintenance initiative “Fitness for Breath” offered by The Lung Association – Ontario. It serves people with COPD, as well as other chronic lung diseases such as severe asthma and pulmonary fibrosis. Currently, there are more than 20 “Fitness for Breath” programs offered in community fitness centres across Ontario.

If there is no PR or exercise maintenance program near you, here are a couple of tips to stay active:

· Learn more about the importance of exercise (both aerobic and strength building) with COPD:

· Include various strengthening exercises for your upper and lower body—find related resources at and

· Follow along with the exercise video from the Toronto Western Hospital PR program. The video incorporates gentle movements, stretches, strength training, balance and flexibility and breathing techniques while allowing you to work at your own pace:

· Here is another example of exercise videos on Feeling Fit Club on youtube (extra):

• Simple mini movement from Active Aging Canada on youtube (extra)

· Make exercise your priority every day or at least on those days when you are less tired

· Include breathing exercises in your routine to help increase the strength of your respiratory muscles

· Start slowly and increase your effort every day (a few extra minutes of walking or one extra repetition)

· Warm up before and cool down after exercising every time

· Don’t overdo it – stop and rest whenever you get too short of breath

· Make sure you do some pursed lip breathing while you are resting

· Even if you can’t exercise try to stand up and move around every 20 -30 minutes—avoid sitting for long periods of time

· Continue to take all of your prescribed medications

· The Air Quality Health Index (AQHI) can help you to monitor outdoor air quality and adjust your outdoor activity accordingly—find out more at On those days when you know that smog levels will be high, you may decide to limit your time spent outdoors and exercise indoors. You may be more comfortable staying inside in a cool environment that is air-conditioned or shaded.

AQHI Scale
Try to exercise regularly or you will lose the benefits of it. Aim for at least three times per week. Physical activity can help you maintain independence, increase energy level, improve mood and could help keep you out of the hospital.

If you have questions how to get more active or to order more resources on COPD,
Call The Lung Association-ON Lung Health Information Line at 1-888-344-LUNG (5864),
E-mail or visit