title: Palliative care in chronic obstructive pulmonary disease.
abstract: Chronic obstructive pulmonary disease (COPD) is the only major worldwide cause of mortality that is currently increasing in prevalence. Furthermore, COPD is incurable, and the only therapy that has been shown to increase survival is oxygen therapy in selected patients. Compared to patients with cancer, patients with COPD experience similar levels of pain, breathlessness, fatigue, depression, and anxiety and have a worse quality of life but have comparatively little access to palliative care. When these patients do receive palliative care, they tend to be referred later than patients with cancer. Many disease, patient-, and provider-related factors contribute to this phenomenon, including COPD's unpredictable course, misperceptions of palliative care among patients and physicians, and lack of advance care planning discussions outside of crisis situations. A new paradigm for palliative care would introduce palliative treatments alongside, rather than at the exclusion of disease-modifying interventions. This integrated approach would circumvent the issue of difficult prognostication in COPD, as any patient would receive individualized palliative interventions from the time of diagnosis. These points will be covered in this review, which discusses the challenges in providing palliative care to COPD patients, the strategies to mitigate the challenges, management of common symptoms, and the evidence for integrated palliative care models as well as some suggestions for future development.
authors.affiliation: Western University, Department of Family Medicine, London, Ontario, Canada.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Lilly
authors.affiliation: Division of Palliative Care, Department Family and Community Medicine, University of Toronto, Baycrest Health Sciences System, Toronto, Ontario, Canada. Electronic address: Hsenderovich@baycrest.org.
authors.forename: Helen
authors.initials: H
authors.lastname: Senderovich
mesh_terms: D032722:Advance Care Planning / Q000458:organization & administration; D003422:Critical Care / Q000379:methods; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004417:Dyspnea / Q000628:therapy; D006801:Humans; D010102:Oxygen Inhalation Therapy; D059408:Pain Management / Q000379:methods; D010166:Palliative Care / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life
keywords: Advance care planning; Chronic obstructive pulmonary disease; Palliative care