The sad truth about cigarettes is that although they may not kill smokers outright, survival can mean years of decline in and out of hospital, constantly out of breath.
Chronic obstructive pulmonary disease, or COPD, is largely neglected in health news because of its taint from tobacco smoke, which causes up to 90 per cent of cases. Yet about 13 per cent of Canadians over 35 have it, two-thirds of the cases undiagnosed as current and former smokers chalk up their wheezing, gurgling lungs and shortness of breath to aging.
As research continues to show the rising prevalence of COPD, health authorities across the country are trying to improve access to pulmonary rehabilitation, a specialized physiotherapy aimed at helping patients make the most of their reduced lung capacity.
Nothing can turn back permanent lung damage, but exercise, education and camaraderie can make a difference in how people feel and function, says Pat Camp, a PhD physiotherapist and head of St. Paul's Hospital's Pulmonary Rehabilitation Clinic in downtown Vancouver.
"It doesn't necessarily take a lot to get a huge improvement," says Camp. "You can have great gains when you're really sick."
While a healthy person might have to push hard to get past an exercise plateau, someone with COPD - an umbrella term that includes emphysema and chronic bronchitis - could reduce their risk of hospitalization by half with an hour of walking each day, says Camp.
That is because sedentary muscles use more oxygen than fit ones to do the same task, so any gains in tone and strength will require less oxygen overall.
"The fundamental thing we're doing is making the rest of the body more efficient to create less demand on the lungs," explains Camp.
Key features of COPD are narrowed airways and rigid air sacs deep within the lungs that won't allow a full exhalation.
This leaves sufferers constantly taking short, shallow breaths. But techniques like bending forward and slowly breathing out through pursed lips can get more air out, allowing a slightly deeper breath to follow.
Randy Clyne, 68, was diagnosed with COPD in 2010 when the only way he could walk a block was by stopping at each parking meter along the way to catch his breath.
He uses oxygen at all times now - carrying a small canister in a holster at his side - and says the rehab program at St. Paul's made it possible for him to keep mobile.
"I attribute my life to this program. My ability to function in a six-minute walk test has improved 55 per cent since starting the program," says Clyne, who is now able to volunteer at Gordon Neighbourhood House in Vancouver's West End. "It's about building up your body again because you become sedentary as your condition deteriorates.
"I couldn't even speak without oxygen before, which is important in an emergency."
That is the kind of progress
Dr. Sharla-Rae Olsen would like see in her patients in Prince George, but the northern city's single pulmonary rehab program launched this spring is already full and has a waiting list.
"We have a brand new program and... I've flooded it with people," says Olsen, the only respirologist practising in the Northern Health region that serves 300,000 people.
As elsewhere in the country, COPD is the leading cause of hospital admissions from a chronic condition racking up multi-billion-dollar health care costs across the nation each year. In Northern Health, says Olsen, 30 per cent of those patients are readmitted within a month, a rate higher than any other illness.
The problem is that patients get just well enough with proper medication and physiotherapy to be discharged from hospital, but they are not fully able to cope at home.
Rehab programs have demonstrated that they can reduce readmissions by making patients physically stronger for daily tasks and also educating them about managing the condition. Many can self-medicate with antibiotics when they first detect a lung infection, for instance, rather than landing in the emergency department. (Although this approach has its own risk of encouraging antibiotic-resistant bacteria.)
While smoking rates are dropping among young people in the North, Olsen says she expects the burden of COPD to rise sharply before it falls.
"It's people who are 50 and 60 years old who have been smoking for 40 years who are going to be developing lung disease and COPD. So in the next 20 years, we're going to see a big peak because those people are aging," explains Olsen. "Baby boomers and the generation right behind them are still generations of heavy smokers, especially in the North. We have another 20 to 30 years of lung disease to get through."
As a result, B.C.'s Interior Health has created a series of videos to walk patients through exercises they can do in their own homes.
Northern Alberta has taken a slightly different approach, where groups of people with COPD get together in their own towns to exercise and meet experts in Edmonton via video conference.
Combinations of these, with home visits added to a program pioneered in Nova Scotia, have popped up across the country as health officials try to curb hospital admissions due to chronic lung disease.
The most recent Canadian research published in 2007 estimated that about one per cent of people with COPD had access to pulmonary rehabilitation.
Pulmonary rehab programs typically entail two or more meetings a week over six to eight weeks, but vary greatly from community-run groups in smaller centres to sophisticated hospital-based programs found in Metro Vancouver. At St. Paul's, for instance, patients can hook up to on-site oxygen tanks while exercising and the level of oxygen in their blood is constantly monitored so a physiotherapist can push them to do more while making sure it's not dangerous. But that level of medical attention reaches only about 150 people each year who are accepted into the specialized clinic which also conducts research.
