Grant: Banting Postdoctoral Fellowship Program

Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease of the lungs with debilitating impact on individuals' health and quality of life. Combining emphysema and chronic bronchitis, and strongly correlated with smoking/smoke exposure and advancing age, COPD is the 4-5th leading cause of mortality in Canada, accounting for significant morbidity (affects 800,000 individuals annually). COPD patients with advanced stages of disease experience significant airflow limitation, which severely limits basic daily activities of living, such as bathing, walking short distances, or even food preparation. This is largely due to crippling symptoms of breathlessness or air hunger ("dyspnea"), which are often worst first thing in the morning. The basis for these symptoms is poorly understood, and the mechanisms behind morning dyspnea are unknown; however, current pharmacologic therapies are not able to prevent this severe morning dyspnea from occurring. My project consists of two parts. The first will, for the first time, elucidate differences in nocturnal lung function between healthy controls and patients with COPD by thoroughly characterizing their mechanics of breathing before, during, and after sleep. The second will test the effectiveness of a new, twice-daily bronchodilator ('puffer') dosing approach in comparison with the current gold-standard of therapy, the foundation of which consists of a daily long-acting bronchodilator. Specifically, I will examine whether a second, evening dose of bronchodilator improves lung function during sleep and, by extension, relieves severe morning dyspnea. Given our ageing Canadian population, the burden of COPD on patients, their families, and the health care system will grow. A better understanding of how COPD impacts on nocturnal lung function, alongside validation of a promising approach to treating morning dyspnea, would provide crucial insight into managing this incapacitating condition.