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Asthma & COPD: who to see and what helps

Asthma & COPD · Kitchener, Waterloo & Cambridge

Asthma and chronic obstructive pulmonary disease (COPD) are long-term conditions of the airways that cause breathlessness, cough and wheeze. Both are confirmed with a breathing test called spirometry and treated first with inhaled medicine from a physician or nurse practitioner, and both have good evidence for exercise alongside that medicine. CARESPACE’s part is support next to your physician or respirologist: a Nurse Practitioner for the medical side, and a physiotherapist for breathing and exercise.

What asthma and COPD are

Asthma is a chronic inflammatory disease of the airways. What defines it is variation: breathing symptoms that vary and airflow out of the lungs that varies. In an attack the muscles around the airways tighten until the airways are too narrow to breathe through effectively. More than 4.8 million people in Canada have asthma.

COPD is the name for a group of lung diseases, including chronic bronchitis and emphysema, in which the airways are narrowed. It is almost always caused by smoking, and it is marked by flare-ups in which the usual symptoms quickly get worse and stay worse.

Symptoms

  • Asthma: shortness of breath at rest or with exercise, regular coughing, wheezing, chest tightness, and sleep or activity disturbed by any of them.
  • COPD: a cough that lasts, mucus that comes up when you cough, breathlessness during everyday tasks, wheezing, chest infections that hang on longer than usual, fatigue and unexplained weight loss.

Shortness of breath is not a normal part of getting older. If you have these symptoms and no diagnosis, and especially if you smoke or used to, see a physician or nurse practitioner.

Causes and triggers

The cause of asthma is still largely unknown; family history, being born early, exposures at work and obesity all raise the risk. What sets off symptoms differs from person to person. Allergic triggers include dust mites and pollens. Non-allergic ones include smoke and cold air, so a January morning in Waterloo Region can be enough to set symptoms off.

Cigarette smoking is the most common risk factor for COPD. Second-hand smoke, cannabis smoke, dusts and fumes at work, air pollution, severe chest infections in childhood, asthma and an inherited condition called alpha-1 antitrypsin deficiency are the others. Work counts: dust and fumes on a plant or shop floor are on that list.

How they are diagnosed

With spirometry, a breathing test that measures how well your lungs are working. Ontario’s quality standard for asthma says adults suspected of having it should complete spirometry to show airflow obstruction that reverses, with further lung tests if spirometry is normal. For COPD, spirometry is called essential, and the Ontario standard is to have it within three months of developing symptoms. A chest X-ray can help rule out other conditions but cannot confirm COPD. If you have never had the test, ask for it.

When breathing trouble is an emergency

Call 911 for a severe asthma attack. The signs are breathing that is difficult and fast; being unable to speak in full sentences; shortness of breath at rest; lips or nail beds turning blue or grey; the skin of the neck or chest sucking in with each breath; excessive cough, wheeze and chest tightness; sweating; feeling anxious, afraid, restless or very tired; and a reliever inhaler that is not helping. Sit up straight, take your reliever (most often a blue inhaler) as directed, and call 911. Call as well if you feel worse at any point or there is no improvement after the reliever.

Call 911 with COPD, or any breathing problem, if breathing stops; if there is moderate to severe difficulty breathing, meaning trouble talking in full sentences or breathing during activity; for chest pain; for blue lips or fingers; for confusion, agitation or drowsiness; or if you cough up large amounts of bright red blood.

If you have COPD, call your physician or nurse practitioner immediately or go to an emergency department if you cough up more than a few tablespoons of blood; your shortness of breath or wheezing is quickly getting worse; you are coughing more deeply or more often, especially with more mucus or a change in its colour; the swelling in your legs or belly has increased; you have a high fever; or you develop flu-like symptoms. These are the signs of a flare-up, and a written action plan, if you have one, tells you what to start while you get help.

The emergency departments in Waterloo Region are:

  • WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
  • WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
  • Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge

If you cannot get there safely, call 911.

Book an urgent appointment if your asthma is slipping: sleep disrupted by symptoms, daytime symptoms two or more times a week, not being able to exercise normally, doing less because of asthma, or catching a cold or flu. With COPD, see your physician or nurse practitioner soon if your medicine is not working as well as it did, your symptoms are slowly getting worse, a cold brings a fever lasting more than two to three days or a worse cough or breathlessness, you cough up any amount of blood, or you have felt sad, anxious or hopeless for more than a few days.

What the evidence says about treating asthma and COPD

  • Where these points come from. Ontario Health’s quality standards for asthma (2025) and COPD (2023), the Canadian Thoracic Society’s 2023 COPD guideline, the international asthma strategy known as GINA, and three Cochrane reviews.
  • Asthma needs a controller, not only a reliever. Adults and adolescents should not be treated with a reliever inhaler alone; all should receive treatment that includes an inhaled corticosteroid. Everyone should have a written action plan, and inhaler technique should be checked at every opportunity.
  • In COPD, quitting smoking is the best way to slow the disease. Ontario’s standard is that people with COPD are asked about smoking at every opportunity, and those who still smoke are offered medicine and other support to stop.
  • COPD medicine. Everyone with symptoms and COPD confirmed by spirometry should be on a long-acting bronchodilator as maintenance treatment, and be offered influenza, pneumococcal and other vaccinations as appropriate.
  • Pulmonary rehabilitation works for COPD. In a Cochrane review of 65 trials with 3,822 participants, programs of exercise training lasting at least four weeks, with or without education, improved breathlessness, fatigue, quality of life and walking distance compared with usual care. Ontario’s standard is referral for people with moderate to severe COPD who are still limited and breathless on appropriate medicine.
  • Exercise is safe and useful in asthma. A Cochrane review of 21 studies with 772 participants found physical training well tolerated, with no adverse effects reported and better fitness, though no significant change in resting lung function. Its authors say people with stable asthma should be encouraged to exercise without fear of making symptoms worse.
  • Breathing exercises help some things in asthma. A Cochrane review of 22 studies in 2,880 adults with mild to moderate asthma found better quality of life at three months and fewer hyperventilation symptoms, both with moderate certainty. One lung function test showed some improvement; another was inconclusive, on very-low-certainty evidence. Asthma symptoms probably did not improve.

What your physician, nurse practitioner or respirologist provides

Spirometry and the diagnosis, the inhalers, the written action plan, vaccinations, oxygen if it is ever needed, and referral to pulmonary rehabilitation. That is a program you are referred to, and individual sessions with a physiotherapist or kinesiologist do not replace it.

How each CARESPACE service helps with asthma and COPD

Nurse Practitioner

Nurse Practitioners in Ontario diagnose, order and interpret tests, prescribe, and refer to specialists. For asthma and COPD that covers sending you for spirometry if you have never had it, prescribing and adjusting inhalers, writing your action plan and reviewing it with you, checking how you use each inhaler, and referring to a respirologist or to pulmonary rehabilitation when the standards above call for it.

See our nurse practitioner team →

Physiotherapy

A physiotherapist can assess how breathless you get and at what level of effort, then build exercise from a starting point you can manage, with aerobic work and strengthening progressed over weeks. They can teach breathing techniques: pursed-lip breathing can help move air in and out of the lungs in COPD, and breathing exercise programs are the ones studied in asthma. Physiotherapists assess and treat at the first visit. Nothing they do replaces your inhalers.

See our physiotherapy team →

Kinesiology

Staying as active as possible and exercising regularly is standing advice in COPD. A kinesiologist can run a progressive exercise program built around your breathlessness, and carry it on after pulmonary rehabilitation finishes. The same applies before lung surgery: an oncology guideline says exercise before surgery for lung cancer may be recommended, as it shortened hospital stays and reduced complications. Do that with your surgical team’s agreement.

See our kinesiology team →

Other services people ask about

Naturopathic Medicine and supplements. A United States government review is direct: the evidence does not support using complementary approaches in place of proven medical management for asthma. It found too little evidence to recommend any herbal product, no reduction in attacks with vitamin D, and inconsistent results for omega-3s. Herbs can have serious side effects and may interact with asthma medicines, so check with a pharmacist, physician or nurse practitioner before starting one. Acupuncture. The same review calls its benefits unclear: a 2019 review found improved symptoms but not lung function.

Where most people start

With a Nurse Practitioner if your diagnosis has never been confirmed by spirometry, your inhalers are not keeping you well, or you have no written action plan. With a physiotherapist if your medical care is in place and you want to be able to do more with less breathlessness.

How your team works together

Medicine first, movement alongside. The Nurse Practitioner, or your own physician, sets the inhalers and the action plan. The physiotherapist starts the breathing and exercise work, and a kinesiologist can take over the longer-term program. If you smoke, our Quitting Smoking page sets out what helps.

Browse by service: nurse practitioners, physiotherapists and kinesiologists.

What to expect at your first visit

  1. Bring your inhalers and your action plan, if you have one, and any spirometry results.
  2. How it has been. Night symptoms, how often you reach for the reliever, and flare-ups in the past year.
  3. What you can and cannot do. Stairs, walking pace, work, sport.
  4. With a physiotherapist, assessment and treatment at the first visit.
  5. A plan to leave with.

What you can do at home

  • Take controller medicine every day, even when you feel well.
  • Keep your written action plan where you can find it, and act on a COPD flare-up within 48 hours.
  • Learn your triggers and avoid the ones you can.
  • Stay as active as you can, and eat well enough to keep up your strength.
  • With COPD, get a flu shot every year, ask about the pneumonia vaccine, and wash your hands often.
  • If you smoke, get help to stop.

Outlook

There is no cure for asthma, but with proper treatment it can be managed, and well-controlled asthma should not stop you exercising or playing sport. COPD cannot be cured either, but it can be treated: quitting smoking slows it, and medicine, vaccination, rehabilitation and exercise help you stay active. Some people come to need oxygen in time.

Asthma and COPD care in Kitchener, Waterloo and Cambridge

Kitchener. Physiotherapy in Kitchener and Kinesiology in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.

Waterloo. Nurse Practitioner in Waterloo, Physiotherapy in Waterloo and Kinesiology in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.

Cambridge. Physiotherapy in Cambridge. Location: Hespeler Road.

The city pages linked above show the locations and practitioners for each service, with their next availability.

Common questions

What is the difference between asthma and COPD?

Asthma is defined by symptoms and airflow that vary, often with triggers. COPD is almost always caused by smoking and brings a lasting cough, mucus and breathlessness, with flare-ups on top. Both diagnoses rest on spirometry.

Is it safe to exercise with asthma?

Yes, when your asthma is stable. In the research, physical training was well tolerated, with no adverse effects reported.

Can breathing exercises replace my inhaler?

No. Breathing exercises improved quality of life in studies of mild to moderate asthma but probably did not improve asthma symptoms, and nothing supports using them in place of medicine.

Does quitting smoking still help once I have COPD?

Yes. It is the best way to slow the disease.

Where can I get help with asthma or COPD in Kitchener, Waterloo or Cambridge?

CARESPACE has physiotherapists in Kitchener, Waterloo and Cambridge. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.

Do I need a referral?

No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →

Sources

Related conditions

Quitting Smoking
Allergies
Chronic Sinusitis
Long COVID

The CARESPACE Central Reception Team

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Book online with a Nurse Practitioner or a physiotherapist, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.

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