COPD Patient Going Strong – with Exercise and Oxygen

COPD is no match for this veteran. After 22 years in the Air Force – many of them in famously frigid spots – another two decades of public service and a successful battle against a serious arterial disease, Bruce Smith hasn’t let a little thing like the nation’s fourth-deadliest killer slow him down.

The 71-year-old suffers from chronic obstructive pulmonary disease (COPD), a progressive condition that attacks the airways, making it hard to breathe. Only heart disease, cancer and cerebrovascular disease kill more people in the U.S. each year. But that hasn’t stopped him from enjoying his retirement.

Most of all, Smith doesn’t let COPD stop him from taking to the hills of northwest Colorado for hunting and fishing with 12-year-old grandson Matthew. But when they go, Smith makes sure to take along his other companion: the oxygen tank that makes it all possible.

Ironically, he once viewed the oxygen supplies that now help him overcome climbs above 10,000 feet as an opponent. “I had a mental stigma about using it,” says Smith, who received pulmonary rehabilitation services at University of Colorado Hospital and now makes regular visits to the COPD Clinic at UCH. “I thought if I was on oxygen therapy, everybody would think how could I be so stupid to smoke.”

He says he smoked throughout an Air Force career that started in Texas, moved on to Germany and included stops in Montana, North Dakota and Greenland – “I was issued parkas many times during my career,” he quips – as well as Florida and the Pentagon in Washington, D.C.

“When I went in in 1962, everybody smoked,” he reflects. He quit for 12 years after launching a successful civilian career with the state of Colorado that included a stint as director of the Public Utilities Commission. But he resumed smoking in 1995, and continued for five more years before quitting for good in 2000.

“If I had one do-over in life, I wouldn’t smoke,” he says.

The years of smoking left him with COPD, but that was hardly his only physical challenge. Peripheral arterial disease (PAD), a condition caused by narrowing of the arteries in the regions away from the heart, caused severe leg pain that limited his endurance.

“I was in Pulmonary Rehab twice a week in August 2009,” Smith recalls, “but I could only do about four minutes. I couldn’t get much benefit because my leg stopped me.”

But in September 2009, Smith arrived at UCH’s Cardiac & Vascular Center for an appointment with Ivan Casserly, MB, BCh, that ultimately helped to point his life in a new direction. After looking at images of Smith’s leg, Casserly ruled out a minimally invasive procedure to treat the PAD with a stent – a tiny mesh tube placed inside the artery that expands, pressing plaque against the walls of the vessel and improving blood flow.

“But he said, ‘I can fix your leg if you’re up to it,’” Smith says. It meant an open procedure to clean the artery of the clogging debris.

Smith agreed, and Casserly and vascular surgeon Brian Peyton, MD, successfully performed the surgery in November 2009.

“The results,” Smith states, “were magical. I had no pain walking.” A return visit last December showed no re-narrowing of the leg artery, he adds.

His strengthened leg allowed him to attack pulmonary rehab in March 2010 with renewed vigor, but he still resisted using oxygen. In UCH Pulmonary Rehab Coordinator Joan Balik, RRT, however, he met someone equally determined.

“Joan took me under her wing and helped me deal with the physical and mental aspects of having COPD,” Smith says. “She told me oxygen is like medicine for what’s wrong with you. Her secret is she is very calm and matter-of-fact. She lets you self-diagnose and consider the things she says. She’s supportive.”

He pauses. “Her manner said to me – not in so many words – ‘Don’t be stupid. Use the oxygen.’” His unwillingness to use oxygen isn’t unusual, says Bill Vandivier, MD, director of Outpatient Pulmonary Services and the COPD Clinic at UCH.

“Most fight it,” he says, “even after we explain the benefits. It’s a hard thing to get past. People feel like they are wearing their disease on their sleeve, like when they’re in a theater with their oxygen tank going. We just try to help them understand that ultimately they’ll feel better and be able to do more if they use oxygen.”

The regular regimen of pulmonary rehab also helps patients reconcile themselves to accepting the help, Vandivier adds. “It puts people with the same disease together,” he says. “It’s like a support group. Patients form friendships, and they talk about using oxygen, inhalers, and being short of breath. They learn from their peers, and don’t feel as isolated.” That squares with Smith’s experience. “In rehab, everybody’s in the same boat. That was my crew. I got on the treadmill and saw I could do it. It showed the clear benefits of oxygen. I had been crippled. Now I’m fully functional, with the help of the oxygen and Joan.”

Smith provides a perfect illustration of the benefits oxygen therapy and pulmonary rehab can offer COPD patients, Vandivier says. “He’s exceptional because he doesn’t let the disease stop him. He’s maximized his therapy.” Balik says Smith’s motivation and enthusiasm were keys to his success. “Pulmonary Rehab was able to help [Bruce] move along to do the activities that he loves. Upon finishing the program and as he continues on his journey he will always be a patient/oxygen advocate, and others who see him using his oxygen will be encouraged to adopt the method.”

Today, Smith does treadmill work five times a week at a community center in Broomfield, his oxygen tank by his side. “I’m no longer hesitant to bring it in,” he says. When he feels like heading for the hills, he puts tanks in the back of his Explorer. Most of the time, he’s not alone when he visits favorite haunts near Steamboat Lake, Gore Pass and others.

“My goal in life is to live as long as I can for my grandson,” Smith says simply. “He’s a great outdoorsman. We hunt for birds and big game. That happens at altitude, and I need my friendly oxygen.”

Grandfather and grandson each pack a tank as they tramp around the woods. Thanks to that help, Smith was there when Matthew recently bagged his first bird.

“I’ve been very fortunate,” Smith concludes, crediting the coordination of care he received at UCH for his new lease on life. “It was a combination of the surgery and the oxygen. I wouldn’t have achieved what I have without the oxygen.”