March and April’s issues of the BCMJ contain a group of articles on one of the most costly of chronic diseases: chronic obstructive pulmonary disease (COPD). COPD costs society money and scarce hospital beds, but costs the patient far more in terms of quality of life. If one is going to suffer a complication of smoking, better it be lung cancer or coronary artery disease. The former is either quickly fatal or cured and the latter also either kills quickly or allows one to live with reasonably controlled symptoms. COPD is like “spending 10 years drowning,” to quote one of my patients; progressive dyspnea gradually erodes the patient’s quality of life and, thus, their independence. An excellent patient information book written by Dr Rick Hodder of Ottawa in conjunction with a number of his patients is entitled Every Breath I Take, a very fitting name.
All of us are aware of the huge impact that exacerbations of COPD have on hospital resources, being one of the most frequent reasons for admission during the winter months. The average admission lasts 10 days and costs approximately $8000. Of 100 patients admitted to hospital for a COPD exacerbation, around 20 will never go home again, and a significant proportion of the others will be dead within a year. We have yet to see the full impact on the health system of smoking-induced illnesses in all those baby boomers, men and women alike, who vigorously supported the tobacco industry in the 30 to 40 years following the Second World War. The tsunami is rapidly approaching so we had better be prepared. (Many of the soldiers, by the way, got started on the free cigarettes supplied to the armed forces, but that’s another story!)
The patient’s top priority is relief of symptoms. It used to be that all we could offer in this regard was the advice to quit smoking and supplemental oxygen in a few patients. Getting rid of the cigarettes is still the most important thing the patient can do, but finally we are getting some better drugs to help with the dyspnea. I hope the information provided in these two issues will help you, and thereby, your patients, battle this disease.