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From the Toronto Star, Special Supplement on Respiratory Illness

Gzowski's last stand
Broadcaster's final appearance takes aim at the respiratory disease that would soon kill him

Chris Atack
Special to the Star

Canadian icon Peter Gzowski peers out from the TV screen. He has an oxygen tube in his nose, his face is gray, he speaks with obvious effort. He is hosting his last-ever show, With Every Breath, a TV special on the little-known disease called COPD (chronic obstructive pulmonary disease).

First aired on April 28, the show begins with Gzowski admitting his longtime ignorance about COPD. "Most of you are likely just like me before I got my diagnosis," he says with a characteristic twinkle of humour. "We don't know a heck of a lot about it."

In his later years, Gzowski learned far more than he ever wanted to know about COPD. He died of it in January, one of the thousands of smokers and ex-smokers the disease kills each year.

COPD is a catchall name for several diseases which obstruct the sufferer's airflow.The two most common are chronic bronchitis and emphysema.

"Chronic bronchitis we define as cough and sputum most days, three months of the year for two years," says Doctor Sheldon Mintz, Acting Chief of Respiratory Division, Sunnybrooke and Women"s College Health Sciences Centre. "We produce too much mucus, because of irritation of the lungs by cigarettes.

"Emphysema, on the other hand, is a bit like the lung is being eaten out from the inside. The tiniest airways are attacked, and their surface area is decreased. This causes important changes in the way the lungs work and how long they work. Emphysema is also caused by cigarette smoking."

COPD is the fourth largest killer of Canadians, after heart disease, stroke and cancer. It's the only major adult disease that's actually on the increase. Once thought of as a "men"s only" ailment, it's now an equal opportunity illness. At some point in the next few years, it will start to kill and disable more women than men.

Yet COPD was barely on the collective radar screen until Gzowski went public with the news that he had it.

"There are lots of reasons why such a major disease has been so invisible until now," says Dr. Roger Goldstein, Director, Respiratory Medicine at West Park Healthcare Centre, a major Toronto center for COPD patients and one of the doctors who treated Gzowski after diagnosis.

"For one thing, many patients are a little ashamed. Most of them are smokers or ex-smokers, and they have this sense they've brought it on themselves. I think they've been reluctant to draw attention to it because of a certain embarrassment, because the condition is to a large extent self-induced.

"On top of that, it's hard for people to be vociferous about their condition when they"re short of breath. How are you going to walk down the street carrying a banner if you can't walk down the street" People can't really assert themselves if they're too short of breath to speak."

By the time most people are actually diagnosed with COPD, they are very sick. "It's insidious," says Mintz. "It sneaks up, a tiny bit at a time. It"s not like asthma when one minute you"re pretty normal and the next minute you"re pretty sick. For people with COPD, there"s nothing obvious until things get really bad."

The lung has tremendous functional reserve. That's why patient don't start to experience shortness of breath until COPD is already far advanced. Even so, people don't have to be bushwhacked by COPD. A painless, two-minute test called spirometry can detect decline in lung function long before symptoms of breathlessness set in.

"If you've smoked at least a pack a day for 20 years, you should have lung function tests once a year," says Goldstein. "Spirometry will give you an idea of the important numbers very quickly. Smokers should know their numbers just as people with high blood pressure or high cholesterol know theirs."

The key measure of lung function is FEV1 (forced expiratory volume in one second), the amount of air a person can exhale in one second, trying as hard as possible. A decline in FEV1 is a major early warning signal.

Lung function tests are also needed to make a firm diagnosis of COPD. "Sometimes we can't tell just by examining somebody or talking to them whether they have it or not," says Mintz. "Certainly, we can't know how bad it is without doing lung function tests."

Whether diagnosed early or late, a verdict of COPD is never good news. However, it is no longer an automatic death sentence, or even a one-way ticket to total disability.

"Until recently there"s been a culture of hopelessness and helplessness among COPD patients," says Goldstein. "There was the perception that, once you had it, there was nothing to be done. The last few years we"ve learned this is wrong 3⁄4 things can be done. As a result, there"s a new sense of optimism among both health care professionals and sufferers."

The first thing patients must do is stop smoking. Easier said than done, admit Goldstein. Even after diagnosis, some patients wrestle for years with the deadly habit before kicking it. "It's a tremendously powerful addiction. It"s very easy to tell people to stop smoking, much harder to do it."

It took Ron Allard two years to give up smoking after he was diagnosed with COPD. "I had to do it gradually," he says with a laugh. "That was the first life skill I had to lose -- one I shouldn"t have picked up in the first place."

A wide range of smoking cessation programs and aids now exist to help smokers butt out. Community-based counselling programs and telephone support lines give psychological support, while nicotine replacement gum and patches can help ex-smokers control craving in the early days. An anti-depressant called Zyban has also helped some people get their nicotine habit under control. But in the long run, to stop smoking takes an act of will, a personal determination to butt out.

Gzowski, who struggled with cigarette addiction for years, put it like this: "You can spend thousands on personal therapy and professional guidance, or you can stick a carrot in your ear and whistle Four Strong Winds -- if you have enough breath. The method makes no difference. If you've decided to quit, you will. If you haven't, you should get your affairs in order."

Once COPD patients have successfully kicked their habit, deterioration in lung function slows dramatically -- but the damage already done is irreversible. "It's like cutting off an arm," says Mintz. "The arm never grows back, but you can get a prosthesis and work around the disability."

COPD sufferers also learn to work around their disability, ever-present shortness of breath. Education, lifestyle changes, and exercise can help them breath easier and get more out of life.

"Rehabilitation for COPD patients is a very interesting development," says Goldstein. "Evidence for it used to be anecdotal. Some doctors would have success, others wouldn"t. Over last 10 years however, a number of well-designed trials have proved respiratory rehabilitation can definitely improve quality of life for people with lung disease."

Rehabilitation programs across Canada work with sufferers on both an in-patient and outpatient basis. These programs generally offer a combination of education, psychosocial support and supervised exercise training. Rehabilitation is delivered by a multidisciplinary team, usually directed by a doctor and including respiratory and physical therapists and nurses.

Education is an essential part of rehabilitation. "When you know something about your condition, you're more likely to be in control of it," says Goldstein. "We give patients written and visual material, supplemented by one-on-one training in things like how to take medication properly."

Patients in the rehabilitation programs are also given psychosocial support. "This has a number of faces," says Goldstein. "For instance, they're taught to plan their days so they don't exhaust themselves in the first hour. They're also taught relaxation therapies to use when they feel short of breath. This is important, because if patients feel they're asphyxiating, it's easy to panic. They're taught to take control of their condition rather than letting the condition control them."

With COPD, simple acts become tests of endurance. Even getting dressed can leave patients gasping for air. "During rehabilitation, we teach them the tricks of the trade," says Goldstein. "For instance, we show them how to get dressed in a way that doesn"t make them short of breath. Healthy people put on their pants by on standing on one leg, holding their breath. Someone with lung disease learns to sit on a chair and breath regularly."

Patients in rehabilitation also participate in an exercise program which includes light weight lifting, workouts on a treadmill or an exercise bicycle and leisure walking As their physical condition improves, they often find they are less short of breath.

Learning new life skills helps COPD patients cope. So do medications which allow them to breath easier. So does portable oxygen, which lets some patients move around more freely.

Even so, life with COPD is no picnic. Lung function continues to deteriorate with age. Colds or flus can send patients to hospital if not controlled early. Shortness of breath is a constant problem.

"You have to admire the extraordinary courage some of these people have," says Mintz. "I've seen people in my office who are too short of breath to comfortably brush their teeth, yet they soldier on. Good for them."

Soldiering on is what it's all about. "You start realizing you're losing little bits of life skills," says Allard. "I used to be quite a walker. Now I can't even go a city block. I have to sit down halfway to catch my breath.

"Every day is a new challenge. You don't fight the challenge, you go with it and try to beat as many as you can in a day. You do what you can for yourself and for others."

Gzowski sums up with his usual succinctness. "You can live well with COPD," he tells viewers at the end of his last show. "But you can live better without it."

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