Originally published in The Ottawa Citizen October 9, 2003
Original Title: Smoking out the silent killer

Take a regular diameter (pencil eraser) size straw and breathe through it while pinching your nose for five minutes. How many would be able to complete this task before gasping for air? Everyone understands the panic that envelops us when we cannot breathe. This universal response is one of our greatest fears. Despite this, an increasing number of people experience and live with the straw reality and are slowly suffocating to death.

Among the common fatal diseases, only one continues to buck the trend of diminishing incidence: chronic obstructive lung disease or COPD. Although air and industrial pollution and hereditary factors contribute to COPD, 90 percent is due to long-term cigarette smoking or passive exposure to second hand smoke.

COPD blocks the large and small airways of the lungs. A collection of diseases (emphysema, asthma and chronic bronchitis) contribute to chronic cough, difficulty breathing, increased mucous secretions within the lung’s airways (bronchi), impairment of the lungs ability to oxygenate the blood and airway obstruction.

Delicate air sacs at the end of the airways (alveoli) oxygenate the blood. Oxygen passes through the wall of the alveoli into the red blood cells in the bloodstream. Carbon dioxide follows the reverse path back into the lungs to be exhaled. The alveoli’s destruction forms cavities or holes within the lung tissue becoming “dead space” or emphysema. COPD is irreversible, destroys the lung’s natural ability to exhale and gets worse from year to year.

The normal elastic nature of the lung that is responsible for exhaling is destroyed. The lung remains permanently inflated with stale air with little means to forcefully breathe it out. Indeed, COPD sufferers breathe rapidly and shallowly to try to exchange what little oxygen they can with the bloodstream. They suffer tremendous debilitating effects of this disease: oxygen tanks in tow, minimal exercise capacity, social isolation and little to no energy to perform routine activities such as transferring from a sitting to standing position.

In 1997, Health Canada reported it to be the fourth leading cause of death in men and seventh for women killing 9618 Canadians and overall the fifth leading cause of death in Canada. The past 30 years has seen a 400 per cent increase in COPD deaths.

It is the fourth most common cause of hospitalization for men and sixth for women. It is truly a silent epidemic and is the only leading cause of death that increases every year. The majority of people affected are over the age of 60.

Other more noted diseases garner more attention but left to its druthers, COPD will supplant many of the diseases we diligently work to eradicate or control. Present trends indicate it will be one of the leading causes of death in Canada within the next ten to 20 years. The journal Lancet reports by 2020 it will be the third leading cause of death in the world.

The death rate for men should stabilize by 2016 because of their declining smoking rate. Women, who continue to provide the cigarette companies with increasing earnings and sales, will see their death rates triple by 2016 surpassing men. Indeed there is growing evidence women are more susceptible to the deleterious effects of smoking than men.

These numbers may indeed be an under-reflection of the problem because the Canadian National Mortality Disease Database does not record COPD as a cause of death and the public has difficulty recognizing the early stages of the disease.

The 1998/99 National Population Survey indicates 500,000 Canadians or 3.2 per cent of the adult population were diagnosed by a health professional with chronic bronchitis or emphysema. The burden upon hospital services will not wane. In 1995, 51,684 hospital discharges and 12,478 days were related to complications of COPD.

While COPD is a significant cause of death, the economic and social implications of the disease are a heavy burden. Health Canada estimates the treatment of respiratory illnesses like asthma and COPD cost $4.3 billion (1993 dollars) with COPD accounting for 75 per cent of the total.

This year 60,000 Canadians with COPD will end up in hospital increasing to 120,000 by 2016. It is an incurable illness and treatments to counter the disability are fair at best.

COPD sufferers lose contact with the outside world, lose their independence, control and confidence as they become reliant on others for their care. They lose hope because they discover they are not the person they used to be and witness the relentless deterioration of their condition.

The debilitating effects of chronic disease are legion. It is an imperative of modern medicine to alleviate suffering and reverse the effects of chronic disease upon the physical and spiritual well-being.

COPD is a preventable illness that frustrates the hell out of families and health-care professionals who witness the suffering and misery that it leaves in its wake. Please consult your doctor about quitting smoking and seek early treatment if you have concerns about COPD.

The Lung Association’s excellent web site: http://www.lung.ca/breathworks/D01.html and http://www.on.lung.ca/yourlungs/lungdisease.html or call The Lung Association’s Information Line at 1-866-717-2673.
© Dr. Barry Dworkin 2002