COPD epidemic

Deana Stokes Sullivan
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Chronic lung disease leading cause of hospital admissions

Chronic obstructive pulmonary disease (COPD) is becoming a "major" health concern throughout Canada, according to a St. John's internal medicine and respiratory disease specialist.

Dr. Nigel Duguid says a COPD epidemic is affecting about nine to 10 per cent of Canadian adults over 40 and about 20 per cent over 70 years of age.

Dr. Nigel Duguid. - Photo by Joe Gibbons/The Telegram

Chronic obstructive pulmonary disease (COPD) is becoming a "major" health concern throughout Canada, according to a St. John's internal medicine and respiratory disease specialist.

Dr. Nigel Duguid says a COPD epidemic is affecting about nine to 10 per cent of Canadian adults over 40 and about 20 per cent over 70 years of age.

"It's the leading cause of admissions to Canadian hospitals currently, over and above any other chronic medical condition," Duguid said in an interview.

"We're seeing patients with acute exacerbation of COPD on a daily basis in our emergency rooms, and this problem has basically doubled in the past 25 years."

Duguid is seeing many more COPD patients in St. John's emergency rooms today than he did 25 years ago, and said there's been a doubling of admissions and hospitalizations for women.

"It used to be two men for every one woman; now it's one to one and overall it's doubling," he said.

Part of the reason, he said, is the fact that cardiologists are doing a great job today treating heart disease with medications and surgery, and people, who might otherwise have a heart attack at 60 or 65, are living a lot longer. Another factor is what Duguid describes as the end results of the cigarette smoking epidemic in the middle of the last century. He hopes this will change in another 20 to 30 years because today only about 20 per cent of Newfoundlanders smoke, compared to 40 to 50 per cent some 30 to 40 years ago.

He estimates about 90 per cent of patients with COPD have been smokers in the past, but there are many other causes.

"We think there are genetic susceptibilities," Duguid said, explaining that some people can develop COPD with very light smoking, while some heavier smokers appear resistant.

"We suspect also that some individuals with chronic lifelong asthma who've never smoked may get COPD later on," he said, "and there are other causes, including childhood respiratory infections, second-hand smoke, air pollution, exposure to wood smoke, all of which can predispose you to COPD."

Simply put, Duguid said COPD is the end result, most of the time, of "environmental agents, superimposed upon a genetic predisposition."

If left untreated, he said, it can become very severe, a terrible disease for patients and a major burden on health-care resources.

But early diagnosis and treatment can improve patients' quality of life and prevent hospitalizations. "It's possible to pick this condition up much earlier than we are picking it up with very simple breathing tests," Duguid said.

But the illness is still underdiagnosed.

"About half the Canadians who have COPD don't know they have it," Duguid said, adding that only about one-fifth of Canadians actually know what COPD is.

He said people often attribute their increased shortness of breath to aging and the chest colds they get to minor bronchitis, when these are often worsening symptoms of COPD, which can be quite incapacitating and lead to "frightening episodes" and hospitalizations.

Winter can be a difficult time of year for COPD patients. Duguid said the average person with COPD will have two to three flare-ups per year.

Where other people might have a head cold with a runny nose, sore throat and cough for a few days, he said, the same virus in a COPD patient can affect their breathing tubes and chest. They may get a secondary infection, which can exacerbate their COPD, cause worsening shortness of breath, cough and mucous production. Their airways, which are already narrowed down, become more narrow, making them quite ill for a week or two. It can even take several months for the more severe COPD patients to get their chest back to normal, Duguid said.

Seasonal influenza and H1N1 also pose problems for COPD patients. In November, Duguid said he saw patients who had to be admitted to hospital from COPD complications triggered by the H1N1 virus.

Any upper respiratory tract infection, including colds and flus, can make COPD symptoms worse, he said, which is why seasonal flu shots and H1N1 shots were recommended for all patients with chronic lung disease. Duguid also recommends pneumonia vaccinations for these patients.

Duguid said any family physician can order a breathing test for a patient. It only takes about 10 to 15 minutes and all hospitals in the province are equipped to conduct the test, he said. Patients might have to wait two to three months to get the test, but Duguid said a couple of months isn't a significant concern considering COPD is a lifelong condition.

The treatment for COPD includes smoking cessation, inhaled bronchodilators and often long-acting bronchodilator/steroid combinations.

Duguid said maintaining good nutrition is also important to ensure patients are neither underweight nor overweight.

Regular exercise is also recommended.

"We encourage everyone with COPD to be active, which seems a bit paradoxical when you think about it. ... There's no question that people who are breathless from COPD get less breathless if they actually start exercising, like simple walking half an hour, five days a week at whatever speed they can with stops, that's fine."

If cold outdoor air during winter exacerbates a patient's shortness of breath, Duguid said just walking indoors in a gym or even a mall can help.

dss@thetelegram.com

Geographic location: St. John's, Canada

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