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New report highlights knowledge gaps in COPD – a disease that one million Canadians do not even know they have

Prior to 2020, the Lung Health Foundation operated as the Ontario Lung Association. Enjoy this content from our archives.

The Ontario Lung Association report, Helping the Missing Million, aims to improve the diagnosis and treatment of COPD in Canada

Toronto, Ontario – October 28, 2019 – Helping the Missing Million, a national report released today by the Ontario Lung Association revealed the significant knowledge gaps that exist when it comes to the diagnosis and treatment of chronic obstructive pulmonary disease (COPD).[1]  While two million Canadians live with the disease,[2] an additional one million more may have it without their knowledge.[3]

In a survey of COPD patients, more than half of respondents did not know what COPD was before they were diagnosed.[4] Among those who had experienced at least one symptom, 35 per cent did not speak to their doctor about the issue,[5] while 65 per cent of patients experienced symptoms for at least one year before being diagnosed.[6]

“I had very little knowledge of COPD or how serious it was when I started on my journey, which created challenges when it came to being diagnosed and getting on the right treatment,” says Barbara Moore, COPD advocate and author of blog Catch Your Breath 60, who was diagnosed in 2015. “It’s so important for people at-risk of this disease to promptly seek out medical advice, educate themselves about the symptoms and work closely with their health care team to make sure they can be properly diagnosed and treated as quickly as possible.”

According to the report, better education and improved partnership between patients and healthcare providers is needed to ensure timely diagnosis and optimal guideline-based treatment to improve outcomes and reduce pressures on the healthcare system.[7]

Helping the Missing Million allows us to better understand the specific factors that prevent people with COPD from receiving proper diagnosis and treatment,” says George Habib, President & CEO, Ontario Lung Association. “This understanding will help us work together with patients and healthcare providers to improve education, collaboration and ultimately, improved outcomes for patients.”

Helping the Missing Million: Report

The report provides a number of opportunities and recommendations to improve healthcare providers’ ability to diagnose and treat the disease, including referrals to specialists and access to spirometry, the gold-standard diagnostic test for COPD.[8] In addition, improved drug coverage, awareness and usage of support programs as well as a multi-disciplinary approach to care can all benefit patients with COPD.[9]

“Uncovering barriers to diagnosing COPD will help us better understand how we can care for patients,” says Dr. Andrea Gershon, Scientist, Sunnybrook Research Institute and ICES (Institute for Clinical Evaluative Sciences), Respiratory Physician. “I believe increased access to spirometry testing and involvement of specialists will improve the diagnosis and subsequently the treatment of COPD, and ultimately help affected people lead their healthiest lives.”

The report also argues for a better understanding of treatment guidelines, as it found only 12 per cent of general practitioners and 21 per cent of specialists consistently follow the Canadian Thoracic Society’s treatment guidelines for COPD.[10] Physician data and pharmacological trends research shows an overuse of inhaled corticosteroids,[11][12],[13], which is not aligned with guideline-recommended use and carries a risk of unnecessary side effects.[14]

“This report puts the focus on meeting patient needs and has the potential to make a significant impact on the more than two million Canadians who live with COPD,” says Andrea Sambati, President & CEO, Boehringer Ingelheim (Canada) Ltd. “Boehringer Ingelheim is proud to partner with the Lung Association on this initiative.  This report helped to uncover specific challenges when it comes to the diagnosis and treatment of COPD that can be addressed and improve patient outcomes for Canadians.”

Canadians are encouraged to visit to learn more about COPD and ways to work with their doctors to receive proper diagnosis and disease treatment.

About the Helping the Missing Million Report on COPD

The results of the report were based on two Leger surveys – one of Canadians living with COPD, and one of physicians. The patient survey included 1,102 patients and was completed between October 2 and November 6, 2018, with a margin of error of +/-3.0%.[15] The physician survey included 250 physicians and was completed between October 30 – November 5, 2018, with a margin of error of +/- 6.2%.[16]

This awareness and education campaign focusing on Canadian patients and healthcare professionals was made possible through a partnership with Boehringer Ingelheim (Canada) Ltd.

Read Helping the Missing Million

About COPD

COPD is a lung disease that includes chronic bronchitis and emphysema. With COPD, a person’s breathing passages are obstructed or blocked, making it hard to breathe.[17] Symptoms of COPD include a persistent cough (sometimes dismissed as smoker’s cough), shortness of breath (dyspnea), chest tightness, wheezing or a whistling or squeaky sound when breathing.[18] It is most commonly diagnosed in people over 35 years of age.[19]

Someone with COPD may not realize they are experiencing shortness of breath more often until they have trouble completing simple tasks, such as walking up stairs.[20] People with COPD also often have another illness, such as cardiovascular disease, mental illness, musculoskeletal disease, cancer or diabetes.[21]

Smoking is a major cause of COPD, but other factors such as low birth weight, childhood asthma or lung infections, genetic predispositions, occupational dusts and chemicals, second-hand smoke, wood smoke and other biomass fuel used for cooking can be factors.[22]

About Ontario Lung Association

Ontario Lung Association is the leading organization in Canada working to promote lung health and prevent and manage lung disease. This is done by funding vital research and pushing for innovative ways to help people manage their health. The Lung Association’s role is to improve respiratory health and the overall quality of life through programs, education, research, training, treatment and prevention of lung disease.

To learn more about the Lung Health Foundation, visit
For more information, please contact:
Monica Kocsmaros
Ontario Lung Association

Lucy Hopkins

[i] Helping the Missing Million – Report on COPD. The Lung Association. (2019). Available at

[ii] Public Health Agency of Canada. (2018). Report from the Canadian Chronic Disease Surveillance System: Asthma and Chronic Obstructive Pulmonary Disease in Canada, 2018

[iii] Canadian Thoracic Society. (2010). The Human and Economic Burden of COPD: A Leading Cause of Hospital Admission in Canada

[iv] COPD Survey Results, Leger, 2018.

[v] COPD Survey Results, Leger, 2018.

[vi] COPD Survey Results, Leger, 2018.

[vii] Helping the Missing Million – Report on COPD. The Lung Association. (2019). Available at

[viii] Helping the Missing Million – Report on COPD. The Lung Association. (2019). Available at

[ix] Helping the Missing Million – Report on COPD. The Lung Association. (2019). Available at

[x] COPD Physician Survey Results, Leger, 2018.

[xi] COPD Physician Survey Results, Leger, 2018.

[xii] Suissa, S. Trends of Phamacologic Therapies for Patients with COPD in Quebec. (2018).

[xiii] Tran, DT. Temporal Trends of Pharmacologic Therapies for Patients with Chronic Obstructive Pulmonary Disease in Alberta, Canada. (2018).

[xiv] Tariq SM, Thomas EC. Maintenance therapy in COPD: time to phase out ICS and switch to the new LAMA/LABA inhalers?. Int J Chron Obstruct Pulmon Dis. 2017;12:1877–1882. Published 2017 Jun 23. doi:10.2147/COPD.S138006.

[xv] COPD Survey Results, Leger, 2018.

[xvi] COPD Physician Survey Results, Leger, 2018.

[xvii] The Ontario Lung Association (2019). COPD.

[xviii] The Ontario Lung Association (2019). COPD.

[xix] The Ontario Lung Association (2019). COPD.

[xx] The Ontario Lung Association (2019). COPD.

[xxi] The Ontario Lung Association (2019). COPD.

[xxii] The Ontario Lung Association (2019). COPD.

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