Life and Breath: Respiratory Disease in Canada

Executive Summary

Over 3 million Canadians cope with one of five serious respiratory diseases – asthma, chronic obstructive pulmonary disease (COPD), lung cancer, tuberculosis (TB), and cystic fibrosis. These and other respiratory diseases such as influenza, pneumonia, bronchiolitis, respiratory distress syndrome and sleep apnea affect individuals of all ages, cultures and backgrounds – from children to parents to grandparents.

Life and Breath, the 2007 Respiratory Disease in Canada report utilizes the most recent available data for the surveillance of chronic respiratory diseases in Canada, and illustrates the need for action to help Canadians breathe easier.

Key Points

1. Canada is facing a wave of chronic respiratory diseases. Since many of these diseases can be tied to an aging population, the number of people with respiratory diseases can be expected to increase. The corresponding increase in demand for services will pose a significant challenge for the health care system.
2. Respiratory diseases exert a significant economic impact on the Canadian health care system. Presently, almost 6.5% of total health care costs were related to respiratory diseases (not including lung cancer). This accounts for nearly $5.70 billion in direct (visible) costs of health care, such as for hospitalization, physician visits, research and drugs, as well as an additional $6.72 billion for less visible (indirect) expenses associated with disability and mortality.
   
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3. The quality of indoor and outdoor air contributes significantly to the exacerbation of symptoms of respiratory diseases. While air quality issues are dependent on geography, and solutions may vary according to locale, action to address air quality issues would make a key contribution to lowering the rising rate of respiratory disease in Canada.
4. The increase in smoking among women in the past 50 years has resulted in an increased prevalence of diseases such as lung cancer and COPD among women.
5. Tobacco remains the most important preventable risk factor for chronic respiratory diseases. One in five Canadians currently smoke cigarettes. In the short term, smoking cessation among adults would have the greatest impact on reducing respiratory diseases, such as lung cancer and COPD.
6. While COPD was once more common in men than women, it is now being reported more in women than in men under age 75. The projected increase in the number of individuals with COPD will have major implications for families and for the delivery of comprehensive hospital and community services.
   
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7. Lung cancer has become a major health issue for women. Both the incidence and mortality rates among older women are increasing, in contrast to the decreases seen among older men.
8. Asthma rates continue to climb. The prevalence of self-reported asthma is higher among women than men and is increasing for both sexes. The data on activity restriction, emergency room visits and hospitalization suggest that many individuals with asthma require help in keeping their disease under control.
9. While Canada's overall tuberculosis (TB) rate is considered low, the rate of TB remains high in Canadian-born Aboriginal peoples and in persons that were born in countries with a high incidence of TB. Challenges to global TB control include the ongoing TB-HIV co-epidemic and the spread of drug-resistant TB strains.
10. Overall, influenza/pneumonia remains a major contributor to deaths and hospitalization among the elderly. It is the leading cause of death from infectious disease in Canada.
11. While cystic fibrosis was once almost exclusively a child's disease, most individuals with this disease are now living into their twenties and thirties. This changing face of cystic fibrosis has major implications for the health care system and the community at large.
    
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12. The decrease in mortality rates for Respiratory Distress Syndrome (RDS) among infants attests to the success of treatment in the modern neonatal intensive care unit. Further improvements in neonatal health will require the prevention of preterm birth, the underlying cause of RDS.
13. The true burden of sleep disordered breathing in Canada is not known, but it is thought to be very common. Sleep disordered breathing is associated with reduced quality of life, decreased cardiovascular health and increased health care utilization, transportation accidents and mortality. Since obesity is a major risk factor for sleep apnea, efforts to promote healthy weights will have the greatest impact on the prevention of this disease.
14. There has been a steady increase in the number of lung transplants performed in Canada, but the number of patients on waiting lists for lung transplantation continues to rise.

Life and Breath demonstrates that Respiratory Disease has a major impact on the lives of millions of Canadians. Please share this report with others so that information about these people, their diseases, and the associated risk factors can help those who make decisions about policies, program and services. Ongoing work on new data sources will continue to provide vital information now and as we face the challenges ahead.

A Final Word

There is no life without breath.