title: Outpatient palliative care for chronic obstructive pulmonary disease: a case series.
abstract: BACKGROUND
  Patients with chronic obstructive pulmonary disease (COPD) have well-documented symptoms that affect quality of life. Professional societies recommend palliative care for such patients, but the optimal way of delivering this care is unknown.
  
  
  OBJECTIVE
  To describe an outpatient palliative medicine program for patients with COPD.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Thirty-six patients with COPD followed in a United States academic outpatient palliative medicine clinic.
  
  
  METHODS
  Descriptive analysis of sociodemographic data, disease severity and comorbidities, treatments, hospitalizations, mortality, topic discussion, and symptom assessment.
  
  
  RESULTS
  Thirty-six patients (representing 5% of the total number of patients with COPD seen in a specialty pulmonary clinic) were seen over 11 months and followed for 2 years. Seventy-seven percent of patients were Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage 3-4 and 72% were on oxygen at home. No patients had documented advanced directives at the initial visit but documentation increased to 61% for those who had follow-up appointments. The most commonly documented topics included symptoms (100%), social issues (94%), psychological issues (78%), and advance care planning (75%). Of symptoms assessed, pain was the least prevalent (51.6%), and breathlessness and fatigue were the most prevalent (100%). Symptoms were often undertreated prior to the palliative care appointment. During the 3-year study period, there were 120 hospital admissions (median, 2) and 12 deaths (33%).
  
  
  CONCLUSIONS
  The patients with COPD seen in the outpatient palliative medicine clinic had many comorbid conditions, severe illness, and significant symptom burden. Many physical and psychological symptoms were untreated prior to the palliative medicine appointment. Whether addressing these symptoms through a palliative medicine intervention affects outcomes in COPD is unknown but represents an important topic for future research.
authors.affiliation: 1 Asthma and COPD Program, Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine , Chicago, Illinois.
authors.forename: Clara
authors.initials: C
authors.lastname: Schroedl
authors.forename: Susan
authors.initials: S
authors.lastname: Yount
authors.forename: Eytan
authors.initials: E
authors.lastname: Szmuilowicz
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Rosenberg
authors.forename: Ravi
authors.initials: R
authors.lastname: Kalhan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015897:Comorbidity; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010166:Palliative Care; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology