Optimizing wellness in chronic obstructive pulmonary disease (COPD) is an emerging theme, in response to the substantial burden of COPD among Canadians. Population surveillance, from the Public Health Agency of Canada, as well as from international initiatives, such as the Burden of Obstructive Lung Disease (BOLD) study, has revealed the prevalence and regional disparities of a condition in which mortality, morbidity and health care resource use often reflect what was happening in the population more than 20 years previously. As COPD emerges to be an important women’s health issue, it raises questions as to how female mortality from COPD can rise at double the rate of breast cancer, why the COPD patient population is still predominantly male and whether women experience breathlessness differently than men.
There is increasing awareness of the frequency and importance of assessing secondary impairments, such as muscle atrophy, an important prognostic indicator. The availability of pulmonary rehabilitation, despite its beneficial effects on exercise and quality of life, remains far behind the demand for services, a care gap unlikely to be filled by institutionally based programs. New models of chronic disease management require the health care system to proactively meet the needs of individuals with chronic conditions, rather than reacting to them through the acute care system. Such approaches occur best in partnership between health authorities and local municipalities. The present supplement includes several examples of this partnership, especially in Alberta and Saskatchewan. An increasing body of evidence supports the importance of exercise training, combined with selfmanagement, as a cornerstone of chronic disease management.