Halifax COPD program gave me my life back, says lung disease patient

Five years ago, even the most routine tasks were toomuch for David Smith: walking upstairs in his Halifax home meanthaving to stop three times before he could reach the top.

Making itto the front door from his chair eight metres away required an equalnumber of rests to catch his breath. A meander around the block wasout of the question.

But the 71-year-old former smoker, who has chronic obstructivepulmonary disease (COPD) related to more than four decades oftobacco use, says his life has been turned around by an innovativeprogram that taught him how to manage the progressive lung diseaseat home.

'A terrible, terrible feeling'

That program, known by the acronym INSPIRED, has given him thetools and confidence to look after his COPD without having to berushed to the hospital when he experiences a flare-up of severebreathlessness, an event that was typically followed by several dayslanguishing in a hospital bed.

Before enrolling in the INSPIRED program in 2011, Smith ended upin the emergency department and was admitted to hospital five timesover a two-year period, each time so short of breath he thought hewouldn't make it.

"You automatically think you're going to suffocate, which is aterrible, terrible feeling, believe me," he said from Halifax. "Itwas just pure panic."

Each episode was also frightening for his wife Phyllis, who wouldtry to help Smith get his breathing under control, but "when he'sin the middle of an attack, he's just not thinking and it gets worseand worse and feeds on itself," she said.

"You try and help but you feel very helpless."

Incurable disease

About 85 per cent of the estimated 800,000 COPD cases in Canadaare due to smoking, which progressively destroys lung tissue,undermining the organs' ability to exchange oxygen and carbondioxide.

"The lungs become increasingly inefficient and the consequencesof that to a patient is one of increasing difficulty with breathingrelated to the obstruction to air flow, both out and into thelungs," said Dr. Graeme Rocker, a respirologist at DalhousieUniversity in Halifax and medical director of the INSPIRED programhe helped found.

Even after quitting smoking, the incurable disease continues toadvance because the damage is irreparable, said Rocker.

"The lungsdon't recover."

'A near-death experience'

Medications can slow the progression of COPD, and they can alsorescue patients when a flare-up of symptoms leaves them gasping forbreath.

The problem, said Rocker, is that many patients don't feelequipped to manage these episodes, which worsen as the person'sanxiety further exacerbates their inability to breathe.

"They've often described this as a near-death experience."

With the INSPIRED program, respiratory and related therapistsvisit the home to teach patients and their families about COPD andstrategies for managing the disease on their own, includingbreathing exercises and an action plan for dealing with flare-ups.

Mounting hospital costs

Patients can also call a help line to get support from the program'shealth team.

"We thought it was the right thing to do because patients andfamilies who live with chronic obstructive pulmonary disease,they're very vulnerable," said Rocker. "They're often isolated andthey've been quite often relatively ignored by the health-caresystem.

"But they account for major human and financial costs thatreally are crying out to be addressed."

Each day a COPD patient is treated in hospital costs thehealth-care system $1,000 on average, with each stay up to 10 daysin length, said Stephen Samis, vice-president of programs for theCanadian Foundation for Healthcare Improvement, which has helpedfund 19 INSPIRED programs across the country, with additionalfunding from pharmaceutical company Boehringer-Ingelheim Canada.

"So it's a huge driver of hospital costs," said Samis, whoseorganization is calling on provincial and territorial governments toprovide funding so the program can be expanded to other areas of thecountry.

Could save millions

Avoiding ED visits, hospital admissions and re-admissions byteaching patients to manage their disease at home could save anestimated $688 million over five years for the 14,000 Canadians withadvanced COPD alone, he said.

"Because what we're seeing is that for every dollar we'respending in this, you have the potential to save $21," Samis said,quoting estimates from an analysis by RiskAnalytica.

"What we're saying is we cannot afford to not start providingthe right care in the right place for these patients. We can't
continue to rely on overburdened emergency departments and hospitalsto provide care that actually is better provided in the home.

"It's much cheaper, and it's much better for the patients andtheir family members."

Dropin hospital visits

The Halifax program alone has reduced the number of ED visits,hospital admissions and days in hospital among its almost 500enrolled patients by 50 to 70 per cent since its inception in 2011,said Rocker, noting that it's a proven concept that should producethe same level of results anywhere in the country.

For Smith, being in the programwhich taught him in what orderand how often a day to take his inhaled medications along with anaction plan for flare-upshas felt like a life-saver.

"After the first four or five days, I could literally see adifference," said Smith, who is back to hunting and fishing and thegardening he had been forced to give up.

"It's really given me my life back."