A retired Toronto-based respiratory specialist hopes his book about the causes and dangers of chronic obstructive pulmonary disease (COPD) will draw attention to what he called a “largely unrecognized” disease.

Dr. Anthony Rebuck, author of Breathing Poison: Smoking, Pollution and the Haze, spoke to The CJN about his latest book, which includes information he gathered from his work with patients, clinical research and statistical data from leading professionals in the field.

“When you ask people, ‘Have you heard of breast cancer?’ Yes. ‘Have you heard of coronary artery disease?’ Absolutely. ‘Heard of stroke? Absolutely. ‘Have you heard of COPD?’ Uh, no, what’s that?” Rebuck said.

“Yet, it is now the third-leading cause of death in the world. It is potentially fatal, it causes enormous suffering, it is incurable, there is no drug that can reverse it, and yet – here is the punch line – it is entirely preventable.”

Rebuck, author of other books including A Doctor’s Torah Thoughts From Singapore, said he was inspired to write his latest book about COPD after spending 14 years living in Singapore, a city in the Asia-Pacific region where air pollution, smoking and “the haze” have contributed to the prevalence of COPD.

“The haze is the illegal burning or clearing of fields that goes on in Indonesia, and it came across in a terrible cloud across the whole of Southeast Asia. It was so bad that in Singapore… cars couldn’t drive because you couldn’t see your hand in front of your face. It was dreadful,” said the England-born doctor who immigrated to Toronto in 1971 to practise respiratory medicine before taking a position with a pharmaceutical company that sent him to Singapore.

“A couple of people at work started saying things to me like their child spent last night in the emergency room with their first attack of asthma. No allergies, no family history. I started to make the connection between the smoky haze and the onset of asthma. Then I looked at the world statistics for COPD and I looked at pollution levels of various countries in Asia, and it seemed to me that it had been underestimated tremendously.”

Rebuck said that according to the World Health Organization, COPD will be the third-leading cause of death and disability by 2020, and more than 2.5 million deaths a year can already be attributed to the disease.

He said this disease, despite its prevalence, is largely unrecognized.

“The book is really an attempt to say, ‘Look, COPD is real, it is among us, it is affecting our friends and family, and it is causing terrible disability. We’ve got to do something about this.’ So, all the causes are completely preventable, if only we can influence ourselves and our governments to do something about it,” he said.

This is a health crisis on a global scale, he warned, and not confined to the Asia-Pacific region.

“Canada is the third-best country in the world as far as pollution is concerned… and the air here is very, very good. The standard of medical care here is excellent… and yet, over 4.5 million Canadians still smoke, and that’s about 18 per cent of the population. I think that’s a tragedy. Now, the prevalence of smoking has been steadily decreasing, but the rate has slowed down over the last few years, so people are not quitting at the rate they were. I think government has an enormous role to play in this,” he said.

Rebuck believes COPD should be approached by governments and the medical community in the same way Type 2 diabetes has been dealt with in recent years.

“For many years, Type 2 diabetes and obesity were viewed in the same way – you just eat too much and you don’t exercise, but there is a lot more to it than that… So much attention is being paid to obesity and dieting and exercise, and I think we need to use that sort of energy and commitment to talk about COPD,” Rebuck said.

“For many years, people thought this was self-inflicted. It’s because of smoking, and you’ve got a smoker’s cough and that is your fault, and why should I commit resources and energy to treating you when you’re just going to go on smoking? There is no realization of just how incredibly dangerous it is. And it’s fatal and incurable.”

He believes that educating the general public and medical community about COPD is essential, and he hopes his book will succeed in getting the conversation started.

“The objective of the book is to try to nudge an awareness in thousands of people, and to recognize the fact that this is a very severe problem in Asia, but not confined to Asia. This has global implications and if this book can even just a tiny bit increase awareness, I’ll be very pleased.”