Palliative Care in End-Stage Chronic Obstructive Pulmonary Disease

2018 ◽  
Author(s):  
Linh My Thi Nguyen
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Symptom Burden ◽  
Symptom Assessment ◽  
Poor Quality ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
End Stage

Patients with end-stage chronic obstructive pulmonary disease (COPD) experience high symptom burden due to severe dyspnea, fatigue, anxiety, depression, disability, and social isolation, resulting in poor quality of life. The caregiving burden for the family is also severe. Despite high symptom burden, because of limited access and difficulty with prognostication, the quality of care for patients with end-stage COPD who receive palliative care compares poorly to the care received by patients with cancer, and the proportion of COPD patients who receive palliative care is much lower than that of cancer patients. Therefore, patients with COPD receive less palliative care and die following more aggressive treatments at the end of life compared to patients with lung cancer, despite having the same preferences for palliative care. This chapter discusses the key issues related to end-stage COPD, including symptom assessment, management, and hospice eligibility.

Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review

2020 ◽  
Vol 34 (8) ◽  
pp. 1030-1043 ◽  
Author(s):  
Stacey J Butler ◽  
Lauren Ellerton ◽  
Andrea S Gershon ◽  
Roger S Goldstein ◽  
Dina Brooks
Keyword(s):  
Lung Cancer ◽  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Health Related Quality ◽  
Obstructive Pulmonary Disease ◽  
Related Quality ◽  
Health Related

Background: Palliative care has been widely implemented in clinical practice for patients with cancer but is not routinely provided to people with chronic obstructive pulmonary disease. Aim: The study aims were to compare palliative care services, medications, life-sustaining interventions, place of death, symptom burden and health-related quality of life among chronic obstructive pulmonary disease and lung cancer populations. Design: Systematic review with meta-analysis (PROSPERO: CRD42019139425). Data sources: MEDLINE, EMBASE, PubMed, CINAHL and PsycINFO were searched for studies comparing palliative care, symptom burden or health-related quality of life among chronic obstructive pulmonary disease, lung cancer or populations with both conditions. Quality scores were assigned using the QualSyst tool. Results: Nineteen studies were included. There was significant heterogeneity in study design and sample size. A random effects meta-analysis ( n = 3–7) determined that people with lung cancer had higher odds of receiving hospital (odds ratio: 9.95, 95% confidence interval: 6.37–15.55, p < 0.001) or home-based palliative care (8.79, 6.76–11.43, p < 0.001), opioids (4.76, 1.87–12.11, p = 0.001), sedatives (2.03, 1.78–2.32, p < 0.001) and dying at home (1.47, 1.14–1.89, p = 0.003) compared to people with chronic obstructive pulmonary disease. People with lung cancer had lower odds of receiving invasive ventilation (0.26, 0.22–0.32, p < 0.001), non-invasive ventilation (0.63, 0.44–0.89, p = 0.009), cardiopulmonary resuscitation (0.29, 0.18–0.47, p < 0.001) or dying at a nursing home/long-term care facility (0.32, 0.16–0.64, p < 0.001) than people with chronic obstructive pulmonary disease. Symptom burden and health-related quality of life were relatively similar between the two populations. Conclusion: People with chronic obstructive pulmonary disease receive less palliative measures at the end of life compared to people with lung cancer, despite a relatively similar symptom profile.

Communication about Palliative Care for Patients with Chronic Obstructive Pulmonary Disease

2005 ◽  
Vol 21 (3) ◽  
pp. 157-164 ◽  
Author(s):  
J. Randall Curtis ◽  
Ruth A. Engelberg ◽  
Marjorie D. Wenrich ◽  
David H. Au
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Physician Communication ◽  
High Morbidity ◽  
Obstructive Pulmonary Disease ◽  
Eol Care

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality and disability Worldwide. For many patients, maximal therapy for COPD produces only modest relief of disabling symptoms and these symptoms result in a significantly reduced quality of life. Despite the high morbidity and mortality, patients with COPD do not receive adequate palliative care. One reason these patients may receive poor quality palliative care is that patient-physician communication about palliative and EOL care is unlikely to occur. The purpose of this review is to summarize recent research regarding patient-physician communication about palliative care for patients with COPD. Understanding the barriers to this communication may be an important step to improving communication about EOL care and improving patient-centred outcomes. Two areas that may influence the quality of care received by patients with COPD are also highlighted: 1) the role of depression, a common problem in patients with COPD, in physician-patient communication; and 2) the role of advance care planning in this communication. Further research is needed to develop and test interventions that can enhance patient-physician communication about palliative and EOL care for patients with COPD, and we describe our perspective on a research agenda in each area.

Characteristics and outcomes of adults with chronic obstructive pulmonary disease and atrial fibrillation

Heart ◽  
2018 ◽  
Vol 104 (22) ◽  
pp. 1850-1858 ◽  
Author(s):  
Michael T Durheim ◽  
DaJuanicia N Holmes ◽  
Rosalia G Blanco ◽  
Larry A Allen ◽  
Paul S Chan ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Symptom Burden ◽  
Smoking History ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

ObjectiveChronic obstructive pulmonary disease (COPD) is associated with the development of atrial fibrillation (AF), and may complicate treatment of AF. We examined the association between COPD and symptoms, quality of life (QoL), treatment and outcomes among patients with AF.MethodsWe compared patients with and without a diagnosis of COPD in the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation, a prospective registry that enrolled outpatients with AF not secondary to reversible causes, from both academic and community settings.ResultsAmong 9749 patients with AF, 1605 (16%) had COPD. Relative to patients without COPD, those with COPD were more likely to be older, current/former smokers (73% vs 43%), have heart failure (54% vs 29%) and coronary artery disease (49% vs 34%). Oral anticoagulant and beta blocker use were similar, whereas digoxin use was more common among patients with COPD. Symptom burden was generally higher, and QoL worse, among patients with COPD (median Atrial Fibrillation Effect on QualiTy-of-Life score 76 vs 83). Patients with COPD had higher risk of all-cause mortality (adjusted HR 1.52 (95% CI 1.32 to 1.74)), cardiovascular mortality (adjusted HR 1.51 (95% CI 1.24 to 1.84)) and cardiovascular hospitalisation (adjusted HR 1.15 (95% CI 1.05 to 1.26)). Patients with COPD also had higher risk of major bleeding events (adjusted HR 1.25 (95% CI 1.05 to 1.50)). There did not appear to be associations between COPD and AF progression, ischaemic events or new-onset heart failure.ConclusionsAmong patients with AF, COPD is associated with higher symptom burden, worse QoL, and worse cardiovascular and bleeding outcomes. These associations were not fully explained by cardiovascular risk factors, AF treatment or smoking history.Clinical registration numberNCT01165710

Dyspnea

2018 ◽  
Author(s):  
Praveen Vijhani ◽  
Farah Kazzaz ◽  
Saadia A. Faiz ◽  
Diwakar D. Balachandran
Keyword(s):  
Heart Failure ◽  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Advanced Disease ◽  
Symptom Burden ◽  
Chronic Obstructive ◽  
Short Term ◽  
Obstructive Pulmonary Disease ◽  
Distressing Symptom ◽  
End Stage

Dyspnea or breathlessness is one of the most distressing symptom experienced by patients with advanced disease such as cancer, end-stage chronic obstructive pulmonary disease, and heart failure. It can be either continuous or episodic (more frequent). Management is usually interdisciplinary and individualized to a given patient. A combination of strategies, such as use of opioids, oxygen, short-term steroids, and counseling, is likely to reduce the symptom burden related to dyspnea.

scholarly journals Quality of life in patients with chronic obstructive pulmonary disease at Pulmonary Community Health Centre Makassar

2018 ◽  
Vol 5 (9) ◽  
pp. 3753
Author(s):  
Elva Cristy Irianti ◽  
Arsunan A. A. ◽  
M. Tahir Abdullah
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Multivariate Analysis ◽  
Community Health ◽  
Pulmonary Disease ◽  
Poor Quality ◽  
Chronic Obstructive ◽  
Quality Of Sleep ◽  
Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) that causes damage to lung conditions such as dyspnea that affects to social and psychological life of the sufferer which overall affects the quality of life. This reaserch aims to focuses on factors related to the quality of life patients with COPD at the Pulmonary Community Health Center, Makassar.Methods: This study used cross sectional study design. Population in this research were patients with COPD who undergo treatment period of October-December 2017 that was as much as 381. Sampling was done by consecutive sampling with total sampel 160 responden. Data analysis consisted of univariate, bivariate with chi square test and multivariate analysis with logistic regression.Results: The results showed that some respondents had poor quality of life (63.8%) and other respondents had a good quality of life (36.3%). Factors related to quality of life were the severity of COPD (p=0.028), comorbidity (p=0.001) and quality of sleep (p=0.005). A multivariate analysis showed that patients with comorbidity were at risk 2,716 times to have poor quality of life.Conclusions: The severity of COPD, comorbidity and quality of sleep were related to have poor quality of life. Patients with COPD should early diagnosis of severity and should change their lifestyle better so as not to aggravate the quality of life.

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