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

Annalisa Carlucci, Aldo Guerrieri, Stefano Nava
European Respiratory Review 2012 21: 347-354; DOI: 10.1183/09059180.00001512
Annalisa Carlucci
*Respiratory Unit, Fondazione S.Maugeri, IRCCS, Istituto Scientifico di Pavia, Pavia, and #Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
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Aldo Guerrieri
*Respiratory Unit, Fondazione S.Maugeri, IRCCS, Istituto Scientifico di Pavia, Pavia, and #Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
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Stefano Nava
*Respiratory Unit, Fondazione S.Maugeri, IRCCS, Istituto Scientifico di Pavia, Pavia, and #Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
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  • For correspondence: stefano.nava@aosp.bo.it
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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.

  • Chronic obstructive pulmonary disease
  • ethics
  • noninvasive ventilation
  • palliative care

Footnotes

  • Provenance

    Submitted article, peer reviewed.

  • Statement of Interest

    None declared.

  • Received February 23, 2012.
  • Accepted March 16, 2012.
  • ©ERS 2012
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Palliative care in COPD patients: is it only an end-of-life issue?
Annalisa Carlucci, Aldo Guerrieri, Stefano Nava
European Respiratory Review Dec 2012, 21 (126) 347-354; DOI: 10.1183/09059180.00001512

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Palliative care in COPD patients: is it only an end-of-life issue?
Annalisa Carlucci, Aldo Guerrieri, Stefano Nava
European Respiratory Review Dec 2012, 21 (126) 347-354; DOI: 10.1183/09059180.00001512
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  • Article
    • Abstract
    • THE DEFINITIONS OF END-OF-LIFE DECISIONS
    • THE PATIENT WITH END-STAGE COPD
    • WHEN SHOULD PALLIATION IN END-STAGE COPD BE STARTED?
    • THE INTERVENTIONS
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