Palliative care in COPD patients: Is it only an end-of-life issue?

Annalisa Carlucci, Aldo Guerrieri, Stefano Nava

Research output: Contribution to journalArticle

Abstract

The presence of acute or chronic respiratory failure is often seen as a terminal phase of chronic obstructive pulmonary disease. A great variability in end-of-life practice is observed in these patients mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues. Indeed, a perceived poor quality of life does not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. It has been suggested to start palliative care earlier, together with curative and restorative care, when there is an increased intensity of symptoms. The patients eligible for palliative care are those complaining of breathlessness, pain, fatigue and depression, which in some studies accounted for a prevalence much higher than 50%. Among comfort measures for palliation, oxygen is frequently prescribed even when the criteria for long-term home oxygen therapy are not met; however, when compared with air, no benefits on dyspnoea have been found. The only drug with a proven effect on dyspnoea is morphine, but not when it is delivered with a nebuliser. Finally, noninvasive ventilation may be used only as a comfort measure for palliation to maximise comfort by minimising adverse effects.

Original languageEnglish
Pages (from-to)347-354
Number of pages8
JournalEuropean Respiratory Review
Volume21
Issue number126
DOIs
Publication statusPublished - Dec 1 2012

Keywords

  • Chronic obstructive pulmonary disease
  • Ethics
  • Noninvasive ventilation
  • Palliative care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Fingerprint Dive into the research topics of 'Palliative care in COPD patients: Is it only an end-of-life issue?'. Together they form a unique fingerprint.

  • Cite this