Chronic Obstructive Pulmonary Disease (COPD) is a slowly progressive respiratory disorder that causes the airways of the lungs to be inflamed and become “obstructed” or blocked.
- Chronic – means it won’t go away
- Obstructive – means partly blocked
- Pulmonary – means in the lungs
- Disease – means sickness
The main symptoms of COPD are shortness of breath and exercise limitation. Cough and phlegm may also be present. People who are diagnosed with emphysema and chronic bronchitis are often considered to have COPD.
Prevalence in Canada
In Canada, COPD is the fourth most common cause of hospitalization among men and the sixth most common cause of hospitalization among women.1 Approximately 500,000 people over the age of 35 have been diagnosed with COPD, and it is estimated that an almost equal number of middle-aged Canadians may also have COPD, but are not aware of it.2 In fact, by 2020, it is estimated that COPD will be the third leading cause of death worldwide.3 It is the only chronic disease with increasing mortality.4
Beyond the obvious impact COPD has on patients and their families, the impact on the Canadian healthcare system is also significant. The annual direct cost of COPD (i.e., diagnosis, hospitalization, emergency room visits) is almost $2,000.00 per patient.5 Add to this, the indirect cost associated with work loss and absenteeism amounting to approximately $1,000.00 per patient.5 Total costs for COPD in Canada cost $1.67 billion in 1998.6
Most people with COPD are not diagnosed until the disease is well advanced. Physicians may use the following criteria to determine if a breathing test, or spirometry, is needed to confirm if a patient has COPD:
- Smoker or ex-smoker, 35 years of age and older;
- Persistent cough;
- Phlegm production;
- Activity-related shortness of breath;
- Frequent colds or respiratory tract infections.
If COPD is detected early, there are steps that can be taken to prevent further lung damage and to help the patient feel better. To help Canadians recognize the symptoms of COPD and encourage early diagnosis, The Lung Association and the Canadian Thoracic Society (CTS) are introducing a new self-assessment tool, The Canadian Lung Health Test, available online at www.lung.ca/lung-health/lung-disease/copd/symptoms.
COPD is a preventable and treatable disease. To optimize early diagnosis, prevention and management of COPD in Canada, the CTS introduced new treatment guidelines in 2003/4. According to the guidelines, the goals of managing COPD are to prevent disease progression, reduce and alleviate breathlessness and other respiratory symptoms, improve the ability to exercise, prevent and treat flare-ups, and reduce mortality. The guidelines recommend a stepwise approach to management, based on severity of symptoms and disability. Key recommendations include:
- quitting smoking – is the single most effective intervention in preventing further damage to the lungs and slowing the progression of the disease; vaccines for flu and pneumonia are recommended to help prevent acute illness;
- education for patients and their family which incorporates a self-management plan and skills to better manage the disease is invaluable
- bronchodilator therapy (to open the airways) should be used to achieve maximal symptom control;
- it is imperative that patients be encouraged to participate in regular physical activity so as to avoid deconditioning; (enrollment in a supervised pulmonary rehabilitation program is preferred and strongly advocated for all patients);
- some patients may benefit from the addition of inhaled corticosteroids (ICSs) for prevention of flare-ups in patients with more advanced COPD;
- supplemental oxygen may be used to prolong life in patients with critically low oxygen in their blood;
- surgery is reserved for consideration in patients with advanced stages of the disease.7,8
The full Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease can be found at www.respiratoryguidelines.ca.
Although there is no cure for COPD, the sooner it is diagnosed, the sooner a person can begin to manage his/her health and improve their quality of life.
- Centre for Chronic Disease Prevention and Control. Editorial Board for Respiratory Disease in Canada, Health Canada, Ottawa, Canada, 2001.2.
- Ernst PP, Bourbeau J, Rainville B, Benayoun S, Suissa S. Underestimation of COPD as a cause of death. Eur Respir J 2000; 16 (Suppl. 31) :13s.
- Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990-2020; Global Burden of Disease Study. Lancet 1997; 349; 1498-504.
- Global Strategy for the Diagnosis, Management & Prevention of COPD: NHLBI/WHO Workshop Report; March 2001.
- K.R. Chapman et al. The Burden of COPD in Canada: Results from the Confronting COPD survey. Respiratory Medicine; March 2003: vol.97 (supplement C), S23-S31.
- Economic Burden of Illness in Canada 1998. Health Canada, Ottawa, Canada, 2002.
- O’Donnell DE et al. Executive Summary. Canadian Thoracic Society Recommendations for Management of COPD – 2003. Can Respir J 2003:10(Suppl A)11A-65A.
- O’Donnell DE et al. State of the Art Compendium: Canadian Thoracic Society recommendations for the management of COPD. Can Respir J 2004:11(Suppl B):7B-59B.