PulmonaryPalliative care in chronic obstructive pulmonary disease
Introduction
Chronic obstructive pulmonary disease (COPD) is a significant cause of mortality and disability worldwide. In fact, COPD is the only disease whose age-adjusted mortality continues to increase. In fact, the global burden of COPD is estimated to increase to 30% by 2030 [1], [2], [3]. Unfortunately, diagnosis is often delayed because patients do not experience significant dyspnea until at least 40% of their lung function is lost [3].
With the exception of oxygen therapy, no standard treatment for COPD has been shown to have a mortality benefit, with benefits limited to only modest symptom control in many patients. The burden of symptoms in COPD leads to markedly impaired function and thus a low quality of life [2], [4], [5]. Symptom burden in end-stage COPD is often equivalent to or worse than, in cancer, as well as the end stages of other chronic disease such as dementia, congestive heart failure, renal failure, and liver failure [6]. Although dyspnea is often the most prominent and debilitating symptom, patients with COPD also experience fatigue, depression, anxiety, pain, weight loss, insomnia, constipation, and incontinence [2]. In patients with this complex array of symptoms, palliative care is ideally suited to address physical, functional, social, and spiritual needs but is less commonly accessed compared to patients with oncologic disease, despite a comparable symptom burden and impact on quality of life [7]. The reasons for this disparity will be explored in the subsequent sections, and suggestions for improvement will be offered based on previously developed models.
Section snippets
Communication and advance care planning
The first step in providing more adequate palliative care to patients with COPD is to be open, honest, and sensitive with patients about the trajectory of their illness and how palliative care can help them [7]. Despite a revised definition of palliative care from the World Health Organization, the term palliative care continues to be equated with comfort and end-of-life care that is offered in place of disease-modifying therapies when such treatments fail and is therefore thought to be only
Conclusion
Although palliative care has been traditionally associated with oncology, it is now up to health care professionals and leaders to make it an essential management strategy for all patients in the end stages of chronic disease, including COPD. Patients with COPD and cancer experience similar symptoms, which are managed the same way regardless of the underlying disease. However, a significant challenge to expanding palliative care for these chronic diseases is difficult prognostication and
Acknowledgments
I would like to thank Shaira Wignarajah who is presently studying for her Bachelors of Science in Kinesiology at York University for her excellent editing efforts in preparation of this material.
References (54)
- et al.
Interventions to support a palliative care approach in patients with chronic obstructive pulmonary disease: an integrative review
Int J Nurs Stud
(2012) - et al.
Health-related quality of life in end-stage COPD and lung cancer patients
J Pain Symptom Manage
(2009) - et al.
Palliative care of chronic progressive lung disease
Clin Med
(2014) - et al.
Top 10 things palliative care clinicians wished everyone knew about palliative care
Mayo Clin Proc
(2013) - et al.
Exploring the care needs of patients with advanced COPD: an overview of the literature
Respir Med
(2010) - et al.
Barriers and facilitators to end-of-life care communication for patients with COPD
Chest
(2005) - et al.
A randomized trial to improve communication about end-of-life care among patients with COPD
Chest
(2012) - et al.
A call for high-quality advance care planning in outpatients with severe COPD or chronic heart failure
Chest
(2011) - et al.
Predicting end-of-life in patients with an exacerbation of COPD by routine clinical assessment
Respir Med
(2010) - et al.
Predicting 1-year mortality rate for patients admitted with an acute exacerbation of chronic obstructive pulmonary disease to an intensive care unit: an opportunity for palliative care
Mayo Clin Proc
(2014)