Featured Speaker Heart Failure Now
Dr. Don Sin
Dr. Sin is a chest physician and a clinical epidemiologist, who works primarily with large databases. In close collaboration with Dr. Paul Man, he also conducts research using a “wet” laboratory to analyze serum samples from chronic obstructive pulmonary disease (COPD) patients for various markers/mediators of systemic inflammation to better understand the link between COPD and cardiovascular diseases.
Dr. Sin graduated from the University of Alberta in 1991 (MD), and specialized in Internal Medicine and became certified in Respirology in 1997. He obtained an MPH degree at Harvard University and did his post-clinical training at University of Toronto.
His major areas of research interest include:
evaluating novel therapies for management of patients with COPD, with an emphasis on anti-inflammatory agents. evaluating novel biomarkers of systemic inflammation in COPD patients evaluating the potential role of systemic inflammation in the pathogenesis of cardiovascular complications among COPD patients
Chronic obstructive pulmonary disease (COPD), comprising chronic bronchitis and emphysema, is a major cause of illness and death worldwide. It is the fourth leading cause of premature mortality in Canada, causing approximately 10,000 Canadians to die annually. Statistics Canada shows an increasing rate of hospital usage and mortality for the disease. In addition, there is evidence that patients who smoke and develop COPD are at increased risk of cardiac disease and sudden death from heart attacks.
Dr. Don Sin is a specialist in respiratory medicine with advanced training in public health from Harvard University and is an expert in population health administrative databases. As the Canada Research Chair in Chronic Obstructive Pulmonary Disease, Dr. Sin is examining the relationships between smoking and COPD and cardiovascular disease as well as COPD drug therapies. There is increasing evidence that inhaled medications, particularly steroids, can influence the severity and progression of COPD and perhaps influence cardiovascular disease.
Dr. Sin’s recent work shows that smokers who develop emphysema and chronic bronchitis have elevated levels of proteins in the blood, which are predictors of heart disease. He is exploring this relationship using a combination of population based research, clinical research, and laboratory testing of levels of these proteins in the blood.
Dr. Sin’s objective is to decrease the individual and societal impact of the lung and heart diseases that are associated with smoking and industrial pollution. His research ranges from the study of molecular interaction to the societal impact of these disorders. Knowledge gained from this research will help basic science researchers and health-care professionals, as well as health-care policy makers.
( Dr. Don Sin, Respirologist, Vancouver, BC ) is in good standing with the College of Physicians and Surgeons.
Well COPD is an acronym that stands for chronic obstructive pulmonary disease, and 20 years ago we used to call it emphysema, or chronic bronchitis, or smoker’s lung or asthmatic bronchitis. And there’s two components of COPD. One is that the airways—the breathing tubes—get progressively narrower, so patients feel as if they’re breathing through a straw. And the other component is the gas exchange units, which are called alveoli, get completely destroyed, and holes form in the lungs of COPD patients.
So together, they cause shortness of breath, cough and sputum production, and occasionally these things flare up, to the point that patients need hospitalization because they can’t breathe, or emergency visits.
We don’t know what causes COPD exactly, but we do know that it’s a complex interaction between your genes and the environment. So some of the environmental factors include cigarette smoking for 10, 20, 30 years. Increasingly we think that marijuana and e-cigarettes can also cause this. Air pollution—both indoor and outdoor—air pollution, poor nutrition, poor exercise and recurrent chest infections.
And the genetic factors are still being worked on, but there are certain genetic mutations that you inherit from your parents that can drive COPD. The most common symptom is shortness of breath with exercise. So many patients don’t recognize that they have COPD, because they think that shortness of breath with exercise is part of the aging process, and they do less and less.
But shortness of breath with walking up a flight of stairs, or walking a block or two, is abnormal at any age, and should prompt patients to think about COPD. Shortness of breath is the most common symptom, and that can start very, very early, without patients actually knowing that that it’s abnormal. Some patients get cough, or sputum production, so occasionally patients come in and say “I’ve had this pesky cough for two years,” and that is clearly abnormal, and should prompt individuals to think about COPD.
So the definition of chronic is persistent, that it doesn’t clear up, and that there is no cure for it. And using that definition, COPD is a chronic disease. Once you get it, it cannot be cured, and without treatment, it will become progressive. In other words, it will get worse with time, maybe much worse, to the point where you may require oxygen 24 hours a day.
One of the reasons why patients with COPD get very sick is that they can get very heavy chest infections. For most people without COPD that’ll be tantamount to having a cold, or maybe a mild flu. But with the same virus, patients with COPD can get very, very sick, to the point where they can’t breathe, or they have terrible fevers, or terrible myalgias—muscle aches; to the point where they can’t function and have to come into the emergency room. So it’s very, very important that patients recognize these symptoms early on—don’t dismiss it as a garden-variety cold, and seek medical attention.
We’ve covered some of the bad news about COPD: that it’s not curable, that it’s persistent and that it can be progressive. The good news is that there’s good treatment for COPD, so when you have these symptoms, seek medical attention with your family doctor or someone you know, and get on therapy immediately, because that will modify the course of your COPD.
Presenter: Dr. Don Sin, Respirologist, Vancouver, BC
Local Practitioners: Respirologist
Dr. Don Sin, MD, FRCP, MPH, Respirologist, discusses treatment options for COPD.
Duration: 4 minutes, 1 second
The most common way COPD is treated is through inhalers. Inhalers can contain drugs that open up your airways. We call them bronchodilators, and there are about 10-15 of them in the market, and your doctor can choose the one that works best for you.
Another class of inhalers contain steroids or corticosteroids. They reduce inflammation and phlegm and mucus in the airways, and they too may be effective for you, depending on whether you have mucus in the airways. And that too can be decided by your physician.
There are other forms of therapies that should also be considered, including yearly vaccinations for influenza, and a pneumonia vaccination every five to ten years. If you’re a smoker, obviously smoking cessation. If you’re surrounded by heavy air pollution, both indoor or outdoor, that should be mitigated; and there are ways to mitigate exposure to those things. And in more advanced cases of COPD, some advanced therapies may be required, including oxygen therapy, or exercise therapy, or even surgery. That can be reserved for those with very advanced disease.
Overall the inhalers are very effective in controlling symptoms of COPD and halting its progression. Overall the prognosis of COPD patients is excellent. People can live with COPD for decades now with proper therapy. The trick here is to get an early diagnosis before the COPD becomes so advanced that you may require surgery, or 24-hour oxygen therapy. So it’s very important to get a prompt diagnosis when you think that you may have the disease, and get started on these therapies early on in the course of your disease.
One of the important drivers of COPD is oxygen or inflammatory stress in the lungs. We can modify that by having a good and proper diet. Lots of greens, lots of vegetables, three square meals a day. And keeping your body weight within the normal range, which is a body mass index, between 22 and about 26. If you start losing weight, that’s a sign that your COPD may be acting up, and you need to see your doctor quite promptly. Obesity is also bad for COPD, because you’re carrying an excess amount of weight on your lungs.
The other thing, I think, to keep in mind, is that regular exercise is a key component of COPD management. And this doesn’t have to be strenuous, but it does involve daily walking—8,000 to about 10,000 steps a day, preferably outdoors. But when the weather gets poor, indoor walking is a very effective way of controlling your COPD.
If you have questions about whether you’re eating properly, please see a dietitian and get some advice about what you should and should not be eating on a regular basis. If you have questions about whether you’re doing the right type of exercise, see an exercise specialist or an exercise program near where you live. If you have any questions about the diagnosis, treatment or prognosis of COPD, please see your doctor.
Presenter: Dr. Don Sin, Respirologist, Vancouver, BC
Local Practitioners: Respirologist