Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.

Life-Sustaining Procedures, Palliative Care Consultation, and Do-Not Resuscitate Status in Dying Patients With COPD in US Hospitals

“…[7][8][9] As more patients who are dying use intensive care treatments, concerns have grown regarding EOL quality, particularity for patients with chronic lung disease. [10][11][12][13] Palliative care is well recognized as an optimal comprehensive approach for critically ill patients, particularly during EOL. 14 Hospital-based palliative care service has been shown to yield positive outcomes regarding patient satisfaction, fewer hospital admissions and in-hospital deaths, less invasive EOL treatments, and reduced hospital expenditure, all of which promote QOL at the EOL.…”

“…7 -9 As more patients who are dying use intensive care treatments, concerns have grown regarding EOL quality, particularity for patients with chronic lung disease. 10 -13…”

Decision and Practice of End-of-Life Care in Lung Disease Patients with Physicians Orders for Life Sustaining Treatment

“…Although the scope of hospice and palliative care has been expanded to patients with terminal non-malignant diseases, some patients with such diseases may live for a long time after diagnosis, and distinguishing between the terminal stage and the dying process may be difficult as their condition repeatedly improves and deteriorates [ 4 , 5 ]. Other patients might not receive proper hospice and palliative care, due to the common occurrence of a sudden transition to the dying process [ 3 , 6 ].…”

“…However, the physical and psychosocial needs, symptom burden, and function decline of patients with non-malignant chronic lung disease resemble those of lung cancer patients [ 7 , 8 ]. In both types of cases, the goals of hospice and palliative care involve relieving the physical symptoms of patients and their families [ 9 ], improving QoL through emotional, social, and spiritual support, and reducing pain [ 4 ].…”

“…Lung diseases, including lung cancer, chronic obstructive pulmonary disease (COPD), pulmonary hypertension, and interstitial lung disease (ILD), have a high risk of death and a negative influence on patients’ daily functions and QoL, due to issues such as dyspnea and depression [ 6 ]. In particular, patients with COPD often need palliative care due to physical symptoms such as uncontrolled dyspnea and fatigue, as well as emotional, social, and functional problems such as depression and anxiety [ 4 ]. They receive more diagnostic tests than lung cancer patients, but less symptomatic treatment and fewer palliative care services [ 10 , 11 ].…”