Pulmonary medicine is a vast specialty which covers varying fields. The Philippine College of Chest Physicians (PCCP) have different councils focusing on each, with the mission to develop and update guidelines, encourage research and registry, while implementing public awareness activities on their respective fields
By Dr. Ma. Bella Siasoco
For the past two decades and more, with due diligence, the Asthma Council promotes the standards for best practice in Philippine asthma management and published several issues of the Philippine Consensus Report on Asthma Diagnosis and Management. Concepts. Recommendations contained in these documents were aligned with those in the Global Initiative on Asthma (GINA), underpinned by evidence and analyzed and evaluated to adapt to national policy, local conditions and practices for the general population.
A major activity of the PCCP’s Asthma Council is its collaboration with Chest (Philippines) in The Handshake Project, an endeavor dedicated to improving quality of life for Filipinos and their families living with asthma by developing, promoting and advocating comprehensive health promotion and disease management approach through patient education. Recognizing that the care of any individual with asthma is a concerted team effort, The Handshake Project invites all healthcare professionals involved in asthma care to various interactive workshops designed to improve their knowledge and their skills in the care and education of patients and families affected by asthma.
The council is the prime local initiator of World Asthma Day activities, an annual occasion organized by the GINA and held on the first Tuesday of May to improve asthma awareness and care around the world.
COPD and Pulmonary Rehabilitation
By Dr. Tim Trinidad
The council has been implementing interventional activities of the PCCP National Strategy to address the high prevalence and under diagnosis of Chronic Obstructive Pulmonary Disease (COPD). The interventions of the strategy are research, education and increase availability/ utility of spirometry.
The Philippine COPD Profile and Survival Study (CPASS) is a nationwide ambitious five-year research study, which will observe and analyze the behavior of 2075 patients. The Burden of Obstructive Lung Disease (BOLD) study will revisit its previous year 2008 cohort in two rural towns in Nueva Ecija. It is anticipated that the results of these studies will help formulate steps on how to better address the COPD problem of the country.
To further develop the proficiency of our front line physicians, the Council is developing a clinical practice guideline based on the GOLD (Global Initiative for Obstructive Lung Disease) strategy. It is expected that the clinical pathway will be completed before the end of the year. There are three ongoing programs in partnership with the Council of Diagnostic and Therapeutic namely: a yearly spirometry workshop is being conducted for the first year: AIRSMART program, which makes available a portable COPD screening device to the members of the PCCP and the Broadening Reach, Enhancing Awareness, and Transforming Health Education (BREATHE) initiative.
BREATHE is a program conceptualized by Dr. Jubert Benedicto includes the holding of lay fora, free clinics and use of digital platforms and social media to disseminate information and promote public awareness on COPD.
The Filipino’s mindfulness of COPD is further enhanced during the yearly World COPD celebration help during the third Wednesday of November. During this celebration the different PCCP chapters and training institutions conducts various activities such free spirometry clinics and pulmonary exercise sessions.
Critical Care, Pulmonary Vascular Disease and Sleep Disorders
By Dr. Teresita De Guia
The Council on Pulmonary Critical Care is probably one of the most dramatic in the field of respiratory medicine. It seeks to deliver care to the very sick patients, whose survival of patients is less than 50 percent. Treatment has to be learned from closely monitoring and point-of-care diagnostic tools.
Knowledge of the application of breathing devices or ventilators are mandatory to current approach to critical care involves not only learning but also teaching and research. Careful history taking, physical examination and appropriate laboratory testing leads the clinicians to better understanding the pathophysiology of critical care. Molecular mechanisms learned amplify the care, and aided by electronic advances had greatly improved the survival of many patients, assisting the failing lung while waiting for recovery and restoration of function.
Conscious of ethical issues arising from the decisions made on critical patients the council had published a monograph entitled, “Withdrawing and Withholding Mechanical Ventilation”’ a guide to other practitioners of caring for critically-ill patients.
Diagnostics and Therapeutics
By Dr. Roland Panaligan
The PCCP Council on Diagnostics and Therapeutics (DATS) is an active unit of the professional organization working towards disease awareness, training and research collaboration.
Every month of June since 2012, the Council conducts Spirometry Performance and Interpretation Training with the help of the Council on COPD and Pulmonary Rehabilitation.
The training is specifically designed to guide fellows-in-training. In 2017, the Council, in collaboration with the industry, introduced the INHALE (Integrated and Harmonized Learning Experience) which is an inhaler aids and gadgets workshop.
This activity combined theories, didactics and hands-on training using latest pulmonary peripherals. The Council will also continue its partnership with the MMDA to monitor lung function and chest radiographs of the agency’s constables and street sweepers. DATS will be steadfast in its commitment to provide training for the college’s younger colleagues with the aim of improving healthcare delivery for the pulmonary patients.
Occupational and Interstitial Lung Disease
By Dr. Joven Tanchuco
The Council on Occupational and Interstitial Lung Disease deals with disorders that possibly hold the least interest of many lung specialists. Although it has improved significantly, especially in the last several years, our understanding of diseases which affect what is called the interstitium of the lungs –interstitial lung diseases, or ILD – pales in comparison to more common airways diseases like asthma and COPD.
Likewise, the outcomes in interstitial lung diseases can just be as dismal compared for example with lung malignancies, but again search for treatments that impact mortality have likewise lagged behind.
It is against this backdrop that this council has focused its efforts: increasing physician awareness about these conditions and empowering them in ways they can help improve the welfare of patients with ILD and occupational lung diseases.
Several lectures on ILD with their current classification as well as updates on pathogenesis, diagnosis and management have been conducted as part of the Annual Chest Convention and independent symposia. It is hoped that through these lectures, lung specialists would have greater ability to diagnose and manage the conditions.
Lung doctors were also informed about provisions through the Social Security System (SSS) and the Employees Compensation Commission (ECC) that seeks to assist those affected by certain work-related disability, including occupational lung disease.
A physician’s assessment is vital in supporting the case for these workers. Thus, the Council has spearheaded dialogues with these agencies and has invited their participation in educational lectures.
Recognizing the need for multidisciplinary care teams in dealing with these diseases, the Council has also conducted collaboration with other sectors involved in the care of patients with occupational and interstitial lung diseases, like the Philippine College of Radiology, the Philippine College of Occupational Medicine, and Occupational Safety and Health Center.
By Dr. Elena Imelda Guia Ladrera
Lung cancer remains to be a formidable disease around the globe and in the local setting. The growing number of afflicted Filipinos puts the pulmonologist with the task of educating the general public on its risk factors, early detection (surveillance) and finally partnering with other relevant specialist in its prompt diagnosis and management.
The PCCP council on lung malignancy aims to harness the pulmonary specialist in refining skills to achieve these tasks by initiating programs, educational activities and workshops. Top of the list to do is to create a Lung cancer clinical practice guideline (CPG) participated by relevant specialist. Secondly is to embark on lay fora specifically aimed on public awareness regarding the risk factors, early signs and symptoms and treatment for lung cancer. Lastly is to support forum on the updates regarding the current treatment and diagnostic tools for lung cancer.
By Dr. Alberto Rizal Nolido Jr.
The Pulmonary Infection Council, headed by Dr. Rizal Alberto Nolido, is an active arm of the Philippine College of Chest Physicians (PCCP) advocating lung protection from pulmonary infections such as flu and pneumonia. Patient education is done through various modalities, such as media kits for both flu and pneumonia, information posters for lay people shared with Watson’s pharmacy, and through numerous TV guesting interviews (which started way back 2013).
The council has also been busy in coming up with Clinical Practice Guidelines (CPG) for Ventilator-Associate Pneumonia (VAP) Diagnosis. This was done through Evidence Based Medicine (EBM) in which numerous articles went through meticulous Critically Appraised Trials (CAT) and grading of recommendations. Diagnostic studies included were sputum CS, ETA CS, BAL CS, chest x-ray, chest CT scan, blood CS and CPIS. The preliminary report of this CPG was presented in PCCP Annual 2017 convention by Dr. Rudy Pagcatipunan and Dr. Isauro Guiang.
Our council was also involved with collaborating with Philhealth on Community-Acquired Pneumonia (CAP) case rate policies. Effective October 29, 2017, Philhealth members who are admitted for CAP will no longer contend with the minimum length-of-stay requirement to avail of insurance benefits (same goes for AGE and UTI).
It is noteworthy to mention that the council has conducted two lung infection summits in the past. We are currently planning to continue the summits to empower our pulmonary specialists more in the area of pulmonary infections.
The council also has an active Twitter account where lung infection updates from all over the world are shared and disseminated to anyone who is interested. Chats, debates and journal clubs are encouraged in this Twitter account.
Tobacco or Health and Air Pollution
By Dr. Imelda Mateo
For the past several years, the Council on Tobacco and Air Pollution has actively initiated and participated in various health promotion activities among clinicians, trainees, patients and the general public to increase awareness and promote advocacies against smoking and air pollution.
Led by the dynamic and proactive Council Chair, Dr. Imelda Mateo, the council has grown in membership with the common thrust of improving education, public awareness and generating avenues among health care providers to spread the advocacy against tobacco in creative and interesting ways that adapt to the needs of the times.
In November 27, 2011, Bike for Lungs, a 21-kilometer bicycle tour encompassing the major cities Marikina City, Quezon City and Pasig City was successfully held. It is a health promotion and fundraising activity project of the PCCP, of which the Council was a major supporter, along with the Department of Health and the Metro Manila Development Authority. The goal of the activity was to raise awareness on the effect of smoking and pollution to the lungs.
During the 31st PCCP Annual Convention in March 7, 2012, the council invited Senator Juan Miguel Zubiri and Philip James “Phil” Younghusband, a lead player in our national football team Azkals, as panelists in the Symposium on “Staying Fit and Smoke-Free.” The guests shared their real experiences on how in their respective professions, they are able to promote health and become role-models for Filipinos, especially for the youth. Both of them expressed very positively their commitment to collaborate with the Council and be partners in improving our campaign against smoking.
In May 28, 2012, the Council in collaboration with the National Youth Commission of the Department of Health held the Tobacco Control Summit where youth participants were oriented on the illeffects of smoking and invited to be actively involved in anti-to-bacco advocacy. During the same year, council members have conducted lectures, fora and campaigns among allied health care workers, students and lay individuals on Effects of Tobacco and Addiction, and Smoking Cessation Benefits and Interventions. The council produced and compiled modules, videos, ads and lecture slides for these purposes.
In the following year, on March 6, 2013, the Council organized the Brief Tobacco Intervention Workshop, the post-graduate course during the 32nd PCCP Annual convention. The course included Updates on Tobacco Statistics, Physicians’ Roles on Tobacco Control, and the workshop on Brief Tobacco Cessation Intervention Training. Prior to this, the council developed modules, which were used in a series of workshop among the members facilitated by Dr. Encarnita Limpin, a staunch tobacco cessation advocate and consultant in the Sin Tax Law.
Another major output of the Council is the creation of the Philippine Clinical Practice Guidelines on Diagnosis and Treatment of Tobacco Use and Dependence in 2015. The guideline was designed as a resource and guide for all health professionals to screen tobacco users for dependence and to deliver evidence-based tobacco-smoking cessation management for patients and specific population groups within the context of our local health system and available resources.
On top of these, the council has collaborated with government agencies and has played significant roles in representing the college in the formulation of laws and national policies concerning tobacco regulation and taxation. Most recently, the council actively supported the formulation of the Executive Order on total smoking ban in all public places in the country.
To this day, the council members continually meet regularly to plan, innovate and create ways on promoting the advocacy against tobacco and air pollution that will reach all sectors of the society.
By Dr. Jose Hesron Morfe
Established in 1993 to address perceived gaps in TB management among medical practitioners, the Council on Tuberculosis is one of the biggest and most active groups in the College. Through it, the PCCP is committed to promote awareness of TB as a public health issue among members and mobilize chapters to actively participate in the implementation of the END TB Strategy and the Philippine Strategic Tuberculosis Elimination Plan.
The Council provides guidance for its members and other medical practitioners in the clinical management of TB patients through its participation in the development and dissemination of the International Standards of Tuberculosis Care and the Philippine Clinical Practice Guidelines in close collaboration with the Department of Health’s National TB control Program, the Philippine Coalition Against Tuberculosis and other stakeholders. It likewise promotes TB as a research priority among its members and includes TB prevention and control in the competency-based core curriculum for trainees.
By Dr. Virginia delos Reyes
The Council on Pulmonary Sleep Disorders was first established in 2004 as an Adhoc council of the Philippine College of Chest Physicians. The objective of the council is to expand the awareness and education of PCCP members with regards to sleep related breathing disorders. The strategies identified to achieve this objective are through health care provider education, publication of sleep research, and public awareness campaign.
The PCCP sleep council in partnership with the Philippine Society of Sleep Medicine (PSSM) developed the Philippine Clinical Practice Guidelines on the Diagnosis and Management of Obstructive Sleep Apnea and was published in June 2016.
The PCCP in collaboration with PSSM successfully held its joint congress with the ASEAN Sleep Federation in PEP TALKS: Pursuing Excellence in Pulmonology; Trends, Advances & Latest Knowledge in Sleep” last March 2017 at the Philippine International Convention Center. This event was attended by local and international experts and was able to showcase the best of Philippine pulmonary and sleep medicine to our counterparts in the ASEAN region.
Last March 2018, the Sleep Council will be held its Lay Forum on Obstructive Sleep Apnea entitled “Ka-OSA ka ba?” The program consisted of lectures on sleep hygiene, OSA and CPAP compliance. After this, the World Sleep Day 2018 was also held, in collaboration with the PSSM and the World Sleep Federation with the theme “Join the Sleep World, Preserve Your Rhythms to Enjoy Life.”
Other plans will be to establish an online OSA information page in the PCCP website to provide users with basic information regarding Sleep and OSA, list of Sleep Centers, CPAP providers.
To facilitate academic meetings and discussions in Obstructive sleep apnea and sleep health,the council will conduct a Sleep Caravan that will engage PCCP Chapters members, and regional MDs in various parts of the country.
Finally, the sleep council will embark on an OSA community-based prevalence study, using the validated Filipino BQ.
Healing and Integrative Medicine
By Dr. Parkash Mansukhani
Formerly known as the PCCP Council on Complementary and Alternative Medicine (CAM), the Council on Health and Integrative Medicine (CHIMe) was organized by some interested PCCP members in 2001, at the initiation of its council immediate past chairman, Dr. Parkash Mansukhani. This group was convened in the light of the growing concern towards awareness of this field. One of the ad hoc committees of the PCCP, this council was created to look into the non-conventional, popular forms of treatment that are seen today, with particular emphasis on those that deal with or involve pulmonary medicine.
The council aims to educate the Filipinos on the role of Complementary and Alternative Medicine or Integrative Medicine on patient care and to educate the Filipinos on how to choose the appropriate therapy from a simplified evidence-based approach.
The council also helps in strengthening the values in medical education, with emphasis on enhancing the medical school curriculum through suggested activities like standardize bioethics across all medical schools in the country; integrate Mindful Practice in Medical Schools; and offer trainings and workshops for PCCP members focusing on life skills and relevant non-medical topics such as leadership skills, presentation skills, investing for physicians, retirement, and more.
Aug 2018 Health and Lifestyle