Short of breath: For Canadian women, COPD deaths surpass those from breast cancer

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Publication Date: 
Mon, 2014-05-12

Spirometry should be “mandated as a quality improvement initiative” for patients at risk of COPD just like blood pressure screening for hypertension, says Dilshad Moosa, a respiratory therapist with the Ontario Lung Association who also manages education for health care providers for the Ontario Thoracic Society.

One way to help identify patients at risk of COPD is with a screening tool—a simple series of questions—developed by the Canadian Lung Association, she says.

Moosa has spent ten years educating Ontario doctors about lung health issues and says there is still a lack of knowledge among primary care providers about how to do quality spirometry tests and how to interpret them.

Meanwhile, the prevalence of COPD in Ontario (that is, the percentage of the population that is affected) increased by 64 per cent between 1996 and 2007, with more of the burden shifting from men to women, according to a recent Ontario study.

For both men and women between 35 and 80, the “lifetime risk” of a COPD diagnosis is double that of congestive heart failure and, for women, three or four times the risk of developing breast cancer, according to a 2011 a study by the Institute of Evaluative Sciences (ICES) published in the Lancet and based on Ontario data.

COPD accounts for the highest rate of hospital readmissions

The lack of attention to prevention and early diagnosis of COPD is particularly striking when costs to the health care system are considered.

For medical patients, COPD accounts for the highest rate of re-admissions to hospital in Canada. Almost one in five COPD patients was readmitted to hospital within 30 days, according to a Canadian Institute of Health Information study of the period 2010 to 2011. 

Research from Ontario shows that the 11.8 per cent of the population over 35 with a diagnosis of COPD had rates of hospital, emergency and ambulatory visits that were 63 per cent, 85 per cent and 48 per cent higher than the rest of the population over a three year period, according to a 2013 study from the Institute for Clinical Evaluative Sciences (ICES). Rates of long-term care and home care use were 58 per cent and 59 per cent higher.

Lead author Andrea Gershon explained the study did not provide a breakdown by gender of health care usage. “I think that would be a great topic for a future study,” she added.

Cigarette smoking accounts for about 90 per cent of cases of COPD—smoke inhalation damages upper airways and the lungs. The other 10 per cent of cases are caused by second hand smoke, air pollution, occupational exposure and a rare genetic disorder.

It’s true that smoking rates have fallen among women, from close to 40 per cent in 1965, to about 24 per cent in 2001 and 15 per cent in 2011. However, the rise in COPD diagnoses today represents the toll being paid today from the effects of the post WW2 rise in the number of women smokers.

People who smoke have two major respiratory risks—lung cancer and COPD—notes Dr. Anna Day, respirologist at Women’s College Hospital in Toronto. Lung cancer is the leading cause of death from cancer in Canada and, disturbingly, lung cancer diagnoses continue to climb among women even as they fall among men.

Having one does not preclude the other, but the risk of COPD is independent of that of lung cancer, says Dr. Day.

Among Canadian women, smoking rates are highest among those in the lowest income brackets. It is notable that for both men and women, COPD rates are higher among those who live in rural areas and those with lower incomes, according to research from the Institute of Clinical Evaluative Sciences in Ontario.

These facts, together with an element of ageism—the risk of COPD increases steeply at 60 years of age—could well contribute to the relative neglect that the disease has suffered in terms of research dollars and public profile.

Certainly, it is clear that the neglect of COPD as a chronic disease is related to the stigma attached to smoking, together with a degree of victim blaming. “Yeah, yeah, you hear that: ‘You smoked, you deserve it.’ I even got that from my family,” says Donaldson.

However, smoking is an addiction, notes Day, and unfortunately “many doctors think you can’t do much about it.” 

Day, whose rallying cry focuses on prevention and early diagnosis, says she has felt like “a sole voice in the wilderness” as she has tried for the past 15 years to raise the alarm about women’s risk of COPD.

Disturbingly, she says that people can lose up to 50 per cent of their lung function and still not show symptoms of COPD.  Day and her colleagues at WCH advocate that, at age 40 to 45, current smokers— or those with a history of smoking—should routinely be given a spirometry test.

The test, which is the only way to confirm a COPD diagnosis, can detect small airway obstruction, indicating COPD in early stages. Now, however, most people aren’t diagnosed until their COPD is moderate or severe.