Cruise proves breath of fresh air for COPD sufferersBy ROBERTA BAKER
New Hampshire Union Leader
September 16. 2018 9:54PM
WEIRS BEACH — On the main deck of the MS Mount Washington, a singer strums an acoustic guitar and croons “King of the Road.” Nearly 300 guests sway, clap, tap fingers and toes, hum and sing a few memorable stanzas. No one seems to notice the wheelchairs, walkers, oxygen tanks or nasal tubes snaking to portable oxygen concentrators that convert damp room air to something breathable.
It’s the 23rd annual Fresh Air Day cruise aboard the tourist boat, a treasured event equivalent to a jamboree for Granite Staters in their late 50s thru mid 90s who have chronic obstructive pulmonary disease, and struggle daily to inhale and exhale. For them, it’s a chance to socialize and lead a life that approximates normal. Tour buses and nursing home vans have ferried guests from as far as Dover, North Conway and Peterborough.
“For some, it’s the only time they ever get out,” says Capt. Paul Smith, who has skippered 22 of the group’s yearly tours of Lake Winnepesaukee. “If we see people who are happy and smiling, we’ve accomplished something.”
Chronic obstructive pulmonary disease, or COPD, which includes chronic emphysema and chronic bronchitis, has been the third or fourth leading cause of death in New Hampshire and nationwide since 2000, claiming more lives than diabetes and breast cancer combined, according to national and state lung health statistics.
More than 80 percent of cases are caused by smoking, the remainder by persistent exposure to air pollution such as fiberglass, asbestos, sheetrock and other construction dusts, second hand smoke, radon, and a rare genetic condition that increases one’s chances of developing serious lung disease.
Close to 62,000 state residents currently have COPD, according to medical surveys; another 30 to 50 percent remain undiagnosed, according to Breathe New Hampshire, a nonprofit lung health education and advocacy group. Many people at risk mistake early symptoms — increased coughing, wheezing, excess sputum and shortness of breath during routine activities — for persistent “smoker’s cough” or typical changes that accompany aging.
Over time, the irreversible illness causes sufferers to lose lung capacity and struggle with simple activities including taking a shower, getting dressed, climbing stairs, carrying laundry and walking from the house to the car. Promising medications known as biologics that deliver antibodies and fight inflammation are still in clinical trials and two to five years away from approval, medical experts say. COPD is managed by oxygen therapy and ongoing and emergency medications and inhalers that open swollen airways and allow sufficient air to pass.
“If you’re out of breath walking from your house to your mailbox, that’s not a normal sign of aging,” says Alyssa Thompson program director of Breathe NH, which is trying to increase public awareness and early detection through workshops, support groups, and continuing medical education requirements for doctors and primary care providers. Early diagnosis can stall COPD’s progress and extend quality of life through timely medication, pulmonary rehabilitation and lifestyle management, which includes ongoing exercise, learning how to breathe efficiently and quitting smoking.
Complicating early detection are varying diagnostic procedures among medical providers. An equal or greater hurdle is the reluctance of smokers and seniors to report troublesome symptoms, for fear of revealing any condition that might jeopardize their independence or take away a stigmatized but pleasurable habit.
“We’ve got to get rid of the shame and blame game,” says Dr. Albee Budnitz, a retired pulmonologist, now staff physician for Breathe NH. “It’s not a person’s fault if they got addicted to nicotine as a teenager.”
The developing brains of children and teenagers are especially vulnerable to nicotine addiction, says Budnitz, who worries that the popularity among high school students of vaping and juuling — smoking substitutes that deliver ultra-high levels of nicotine — is creating a new generation of addicts. Roughly 50 percent of those who become nicotine-dependent as children or teenagers die of tobacco-related disease in mid-life, research has shown.
“Take a breath, then breathe in further, then breathe again. Then inhale for the fourth time: That’s how much lung capacity someone with COPD has,” says Dan Fortin, president of Breathe NH.
People with severe COPD are often homebound because of round-the-clock oxygen dependence and physical limitations that worsen with inactivity, creating a cycle of declining health — especially in older people.
“The whole thought of driving two-and-a-half hours and going out for the day is incredibly stressful and scary for them,” says Essy Moverman, a respiratory therapist, who came to the Fresh Air cruise Sept. 6 with pulmonary rehabilitation patients from Monadnock Community Hospital in Peterborough. “You’re always thinking, ‘What if I get short of breath?’”
COPD often runs in families because of a shared susceptibility, and because of a smoking habit learned while growing up, modeled at home or encouraged by peers.
Pauline Lucas, 58, of Dublin, her sister, Jackie, 70, of Peterborough and their brother Carl, 57 of Dublin, started smoking around age 10 and have COPD — along with two younger siblings who won’t give it up or begin pulmonary rehab. Pauline quit 10 years ago, after smoking for 35 years, but normal breathing never returned. “I can’t go shopping without oxygen,” she says.
“I said to my doctor, Why am I still wheezing when I quit smoking a year ago?” says Jackie, who only ventures on outings without much walking. “Doing basic chores and housework, even with oxygen, it still takes a while. You have to take your time and take a lot of breaks.”
Over time, compromised breathing limits social activities and increases isolation. Twice a week the sisters attend pulmonary rehabilitation at Monadnock Community Hospital. Jackie looks forward to supervised exercise at a community center three other weekdays, where she mingles and shares coping strategies with kindred spirits who understand what it means to have a “bad air day.”
“It’s like those people are my family,” she says.
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Silver Linings is a continuing Union Leader/Sunday News report focusing on the issues of New Hampshire’s aging population and seeking out solutions. Union Leader reporter Roberta Baker would like to hear from readers about issues related to aging. She can be reached at firstname.lastname@example.org or (603) 206-1514. See more at www.unionleader.com/aging. This series is funded through a grant from the Endowment for Health.