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

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

Making it to the front door from his chair eight metres away required an equal number of rests to catch his breath. A meander around the block was out of the question.

But the 71-year-old former smoker, who has chronic obstructive pulmonary disease (COPD) related to more than four decades of tobacco use, says his life has been turned around by an innovative program that taught him how to manage the progressive lung disease at home.

'A terrible, terrible feeling'

That program, known by the acronym INSPIRED, has given him the tools and confidence to look after his COPD without having to be rushed to the hospital when he experiences a flare-up of severe breathlessness, an event that was typically followed by several days languishing in a hospital bed.

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

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

Each episode was also frightening for his wife Phyllis, who would try to help Smith get his breathing under control, but "when he's in the middle of an attack, he's just not thinking and it gets worse and 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 Canada are due to smoking, which progressively destroys lung tissue, undermining the organs' ability to exchange oxygen and carbon dioxide.

"The lungs become increasingly inefficient and the consequences of that to a patient is one of increasing difficulty with breathing related to the obstruction to air flow, both out and into the lungs," said Dr. Graeme Rocker, a respirologist at Dalhousie University in Halifax and medical director of the INSPIRED program he helped found.

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

"The lungs don't recover."

'A near-death experience'

Medications can slow the progression of COPD, and they can also rescue patients when a flare-up of symptoms leaves them gasping for breath.

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

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

With the INSPIRED program, respiratory and related therapists visit the home to teach patients and their families about COPD and strategies for managing the disease on their own, including breathing 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's health team.

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

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

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

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

Could save millions

Avoiding ED visits, hospital admissions and re-admissions by teaching patients to manage their disease at home could save an estimated $688 million over five years for the 14,000 Canadians with advanced COPD alone, he said.

"Because what we're seeing is that for every dollar we're spending 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 providing the right care in the right place for these patients. We can't
continue to rely on overburdened emergency departments and hospitals to provide care that actually is better provided in the home.    

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

Drop in hospital visits

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

For Smith, being in the program—which taught him in what order and how often a day to take his inhaled medications along with an action plan for flare-ups—has felt like a life-saver.

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

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