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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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    Figure 1.

    Number of publications in peer-reviewed journals in the field of end-of-life care in a) adults with all diseases, and b) adults with chronic obstructive pulmonary disease.

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  • Table 1. Factors to consider when discussing end of life in intensive care unit admission of exacerbated end-stage chronic obstructive pulmonary disease
    Difficult/prolonged weaning from mechanical ventilation
    High in-hospital and 1-yr mortality rate
    Poor quality of life after leaving the hospital
    Need for prolonged intensive nursing and physiotherapist assistance
    Very high frequency of short-term readmission
  • Table 2. Parameters suggested for evaluation of short-term mortality
    Two or more criteria [25]Decision tree [28]
    FEV1 <30% predictedAge <75 yrs
    Oxygen dependenceDyspnoea degree
    One or more hospital admissions in the previous year for an acute exacerbation of COPDFEV1 <50% predicted
    Left heart failure or other comorbiditiesPhysical activity (time spent walking during leisure time)
    Weight loss or cachexiaNumber of exacerbations in the last 2 yrs
    Decreased functional status
    Increasing dependence on others
    Age >70 yrs
    • FEV1: forced expiratory volume in 1 s; COPD: chronic obstructive pulmonary disease. Reproduced from [25] and modified from [28] with permission from the publishers.

  • Table 3. Tools to be considered for treatment of symptoms in end-stage chronic obstructive pulmonary disease in a chronic and acute setting
    SymptomChronic settingAcute setting
    Dyspnoea/breathlessnessPharmacological therapy Physical rehabilitation Oxygen therapy Noninvasive ventilationPharmacological therapy Oxygen therapy Noninvasive ventilation Opioids
    Anxiety and depressionPhysical rehabilitation Pharmacological therapyPharmacological therapy Sedation
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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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