Smoking is to be banned from Vancouver's beaches and parks September 1, 2010.
The number of adults living with chronic obstructive pulmonary disease has soared over the past decade, to the point where one in 10 adults over 35 now suffers from COPD, a new study shows.
At the same time, the research shows that the death rate from the debilitating lung disorder is falling and so too is the incidence of COPD in the population. "It's a good news, bad news story," Andrea Gershon, a scientist at the Institute for Clinical Evaluative Sciences, said in an interview.
"But the bottom line is that COPD is a terrible disease and we should be paying a lot more attention to it," she said.
By far the most common underlying cause of COPD is smoking, but environmental factors such as pollution also contribute.
"The burden of disease we're seeing now started decades ago, when smoking was commonplace," Dr. Gershon said.
One of the principal reasons that the incidence of COPD is falling is because of a drop in smoking rates. In the 1960s, one in two adults smoked; today, it is fewer than one in five.
The research, published in today's edition of the Archives of Internal Medicine, shows that the number of Ontario residents diagnosed with COPD rose to almost 710,000 in 2007, up sharply from 430,000 in 1996.
That is a 65-per-cent increase - 76 per cent in women and 55 per cent in men.
During that same period, the number of newly-diagnosed COPD patients fell to 56,000 a year from 62,000 annually.
That is a decrease to 8.5 per 1,000 population from 11.8 per 1,000.
In the 1996-2007 time period, the number of annual deaths increased to 32,000 from 24,000. But, given the rising numbers of those with COPD, that actually translated into a 24-per-cent decrease in the mortality rate.
"For a long time, COPD was considered as a disease you couldn't do much about, but we're getting much better at treating it," said Dr. Gershon, who is also a respirologist at Sunnybrook Health Sciences Centre in Toronto.
COPD includes a variety of conditions, such as emphysema and bronchitis; it is characterized by blocked lungs and restricted air flow.
COPD patients use a variety of treatments, including bronchodilators (commonly known as puffers) to treat shortness of breath; corticosteroid pills to prevent and treat flare-ups of breathing problems and antibiotics to treat infections that can stress breathing. Vaccines against influenza and pneumococcal disease have also lowered the death rate, and the portability of oxygen tanks has made it easier for people with COPD to lead normal lives.
The new research focuses exclusively on patients who have been diagnosed and treated for chronic obstructive pulmonary disorder, but Dr. Gershon noted that there a number of studies that show that COPD is under-diagnosed.
"Researchers who went out and screened people in the general population found almost 50 per cent had not been diagnosed," she noted.
COPD is an insidious disease that begins with shortness of breath and degenerates into severe breathing problems that place patients at risk from common respiratory infections and lead to blood-clotting problems that trigger heart attacks and strokes.
Symptoms like chronic coughing and wheezing are often dismissed as temporary or the result of aging, and testing - which is done with a simple device called a spirometer - is not done routinely.
"Physicians still aren't good at diagnosing this disease and that's a problem," Dr. Gershon said.
A report published earlier this year by the Canadian Thoracic Society found that treatment of COPD costs the health-care system at least $1.5-billion annually. It also showed that more people are being admitted to Canadian hospitals each year with COPD than any other major chronic illness - including heart attacks - and that the number has been increasing sharply in recent years.
People with COPD have flare-ups - essentially lung attacks - that require frequent and lengthy (read: expensive) hospital stays lasting an average of 10 days. Most people with COPD end up in hospital at least once a year; one in five make two visits, and one in seven have three or more hospital stays annually.
As many as one in three COPD patients in hospital don't get out alive, a testament to the severity of the illness.