The Chronic Disease Affecting Millions of Canadians

What to know about COPD and how to manage symptoms.

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Chronic obstructive pulmonary diseases (COPD) refers to a group of diseases that damage the lungs and make it harder to breathe. Imagine being constantly short of breath or having unrelenting chest tightness. For people living with COPD, the feeling can be suffocating—almost literally, and can severely impact quality of life.

Affecting more than 2 million Canadians, COPD includes diseases such as chronic bronchitis and emphysema. Chronic bronchitis and emphysema are the most common lung diseases, and adults with COPD often have both.

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What causes COPD?

There are many contributing factors, but a history of smoking is by far the number one cause of COPD. Other causes include second-hand smoke exposure, air pollution, repeated lung infections during childhood, and genetics. Occupational exposure to dusts, fumes, vapours and gases has also been associated with COPD. While symptoms of the disease don’t usually appear until later in life, changes to the lung begin many years earlier.

In most cases, COPD is preventable. If you’re a smoker, the sooner you quit, the better. Not only will this reduce your risk of developing COPD, but it also helps to slow down progression of the disease if you already have it.

If you think you’re at risk or may already have COPD, speak to your doctor. A simple breathing test, called spirometry, measures how much and how fast you can move air in and out of your lungs, and can help your doctor make a diagnosis.

“If indeed COPD is present, then the clinician can develop an individualized, management plan to improve the function of the airways so to relieve shortness of breath and improve the ability to increase physical activity,” says Dr. Denis O’Donnell, Professor of Medicine at Queen’s University and a practicing respirologist in Kingston, ON. “Importantly, another central treatment goal is to reduce the risk of future chest infections or “flare-ups” and fortunately this can be effectively achieved using modern treatments.”

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A chronic and progressive disease

The symptoms of COPD—shortness of breath, chronic coughing, increased mucus or phlegm—get progressively worse over time. Contrary to what you may think, feeling short of breath or having trouble breathing isn’t a normal sign of aging. Some people with COPD describe it as feeling like they are breathing through a straw.

COPD also makes day-to-day tasks extremely challenging and can negatively impact mental health. Even simple activities like walking and climbing stairs can be difficult. “If it becomes clear that the ability to engage in normal activities of daily living is steadily declining, over weeks or months, then help is needed and a new clinical evaluation should be requested,” says Dr. O’Donnell.

Perhaps not surprisingly, adults with COPD are also more likely to have depression or other mental or emotional conditions, and report only a fair or poor health status overall. The current COVID-19 pandemic has only made things worse. According to a survey by COPD Canada, roughly 50 percent of those living with COPD have decreased their level of physical activity due to isolation and social restrictions. While physical activity is so important for general wellness, it also helps reduce anxiety and depression. Without that regular exercise, many people with COPD are having a harder time staying positive about their health.

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Goals of treatment

Although there is no cure for COPD, it can be treated and managed to improve symptoms and quality of life. The goal of treatment should be to reduce the frequency and severity of symptoms and limit the number of exacerbations or flare-ups, improving overall health as a result. It’s also important to stay active as regular exercise helps the heart, lungs and muscles work efficiently. Pharmacological therapy such as daily maintenance medications can support your treatment goals, reducing COPD symptoms, while also increasing exercise tolerance. “We now know that modern, long-acting inhaled medications (“puffers”), which open up the narrowed airways, when combined with an exercise program to promote increased physical activity, are very effective in COPD,” says Dr. O’Donnell.

Treatment options

Non-pharmacological options

With physical activity being a key component of treatment, some people with COPD may need extra support to make sure their lungs are up to the task. Pulmonary rehabilitation programs can help teach you breathing and coughing techniques that will make it easier to exercise with COPD. The support from pulmonary rehabilitation has the benefit of not just improving COPD symptoms, but increasing physical and emotional participation in everyday activities, which is key for mental health as well.

It’s also imperative that you quit smoking if you haven’t already. Even if you’ve already been diagnosed with COPD, quitting smoking can help slow the progression of the disease. Don’t go it alone; talk to your healthcare provider about smoking cessation programs, patient counselling and pharmacology options.

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Pharmacological options

Your doctor may prescribe certain COPD medications to help prevent and lessen the severity of symptoms. Every person’s experience is unique and so it’s important to communicate with your healthcare provider about any changes to your lung health, especially if you experience worsening symptoms or flare-ups with increased coughing, phlegm, chest tightness or shortness of breath. It’s also important to let your doctor know about any changes to your overall health including sleep, energy level, and whether you feel your COPD symptoms are preventing you from doing any usual activities.

“[Those living with COPD] should never neglect any new short-term development of worsening symptoms (increased cough and change in the amount and colour of the phlegm, chest congestion and increased shortness of breath) as these are typical features of COPD “flare-ups”,” says Dr. O’Donnell.

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“Patients experiencing such symptoms should therefore contact their healthcare provider without delay to begin immediate treatment (usually antibiotics and steroid tablets),” he says. “Very importantly, the patients and clinician should develop a careful collaborative management plan to prevent further “flare-ups” in the future. Inhaled medications that reduce inflammation of the airways in COPD, called corticosteroids, have been convincingly shown to be successful for this purpose.”

Of the COPD medicines in a daily maintenance inhaler, you doctor may prescribe one or a combination of medicines, including:

  • Long-Acting Muscarinic Antagonists (LAMAs) to help the muscles around your airways relax;
  • Long-Acting Beta2-Agonists (LABAs) which expand the muscles around your airways, helping the airways to dilate; and
  • Inhaled Corticosteroids (ICS) which aim to reduce swelling or inflammation in the walls of your airways.

The most important thing is to be proactive with your health and seek help when needed. If you or a loved one is struggling with symptoms or flare-ups, book an appointment with your healthcare provider today to discuss options that could help you better manage your COPD. Symptoms like breathlessness, difficulty doing routine tasks, increased coughing or sputum production, and even waking up during the night due to COPD are all things your healthcare provider should know about so that they are able to help. Living with COPD can be overwhelming, so a support group may be helpful as well. Speak to your healthcare provider to determine the best treatment plan for you.

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