Chronic obstructive pulmonary disease (COPD) is a progressive illness characterized by irreversible or partially reversible airflow obstruction in the lungs. The main risk factor for COPD is current or past tobacco smoking. The condition is characterized by progressive shortness of breath, often associated with cough or sputum production, resulting in decreases in exercise tolerance, the ability to carry out activities of daily living, and quality of life. As the disease progresses, many people with COPD have more frequent or more severe acute exacerbations of COPD, also called flare-ups or lung attacks.
Worldwide, COPD is a leading cause of morbidity and mortality. The disease results in a social and economic burden that is both substantial and increasing. Despite declining smoking rates in Ontario, COPD is one of the most common chronic conditions. The overall estimated prevalence of physician-diagnosed COPD in Ontario was 11.8% in 2014/15. In addition, more people are living with COPD in Ontario than in the past: The prevalence of COPD increased by 36.6% from 1996/97 to 2014/15. However, it is also estimated that only 41% of people with COPD have received spirometry testing to confirm their diagnosis. In 2014/15, this varied between 30% in the North East Local Health Integration Network (LHIN) and 48% in the Toronto Central LHIN (Physician-Billed Services, Institute for Clinical Evaluative Sciences, 2014–15).
People with COPD also frequently require health care services. COPD is the second-most common reason for hospitalization in Ontario, after childbirth (Hospital Morbidity Database and Ontario Mental Health Reporting System, Canadian Institute for Health Information, 2014–2016). However, there is also variation across LHINs in the rate of hospitalizations and emergency department visits attributable to COPD. In 2014/15, there was a 2.2-fold difference between the highest rate of hospitalization (37.6 per 1,000 person-years in the North West LHIN) and the lowest rate (17.3 per 1,000 person-years in the Central LHIN). Also in 2014/15, the rate of emergency department visits was 5 times higher in the North East LHIN (52.5 per 1,000 person-years) than in the Mississauga Halton LHIN (10.5 per 1,000 person-years). In Ontario, from 2008 to 2011, people with COPD accounted for 24% of hospitalizations, 24% of emergency department visits, 21% of ambulatory care visits, 30% of home care services, and 35% of long-term care residence places. In 2011, the total economic burden of COPD in Ontario, comprising direct and indirect costs, was estimated to be $3.9 billion (direct health care costs alone were estimated to be $3.3 billion).
Although COPD is a progressive illness, there are significant opportunities to improve the quality of life of people with the disease through the delivery of high-quality health care. As most people with COPD are not diagnosed until the disease is well advanced, earlier identification and testing of symptomatic individuals at risk of developing COPD is an essential first step in managing this chronic condition. The goals of COPD management include slowing the progression of airflow limitation; reducing the frequency and severity of and treating acute exacerbations; relieving symptoms such as breathlessness and anxiety; improving exercise tolerance, the ability to carry out activities of daily living, and overall health status; managing comorbidities; and reducing mortality.