title: [Limitations of active therapeutic and palliative care in chronic respiratory disease].
abstract: The issue of intensive and palliative care in patients with chronic disease frequently arises. This review aims to describe the prognostic factors of chronic respiratory diseases in stable and in acute situations in order to improve the management of these complex situations. The various laws on patients' rights provide a legal framework and define the concept of unreasonable obstinacy. For patients with chronic obstructive pulmonary disease, the most robust decision factors are good knowledge of the respiratory disease, the comorbidities, the history of previous exacerbations and patient preferences. In the case of idiopathic pulmonary fibrosis, it is necessary to know if there is a prospect of transplantation and to assess the reversibility of the respiratory distress. In the case of amyotrophic lateral sclerosis, treatment decisions depend on the presence of advance directives about the use of intubation and tracheostomy. For lung cancer patients, general condition, cancer history and the tumor treatment plan are important factors. A multidisciplinary discussion that takes into account the patient's medical history, wishes and the current state of knowledge permits the taking of a coherent decision.
authors.affiliation: Institut de cancérologie Daniel-Hollard, groupe hospitalier Mutualiste, 38000 Grenoble, France.
authors.forename: L
authors.initials: L
authors.lastname: Sakhri
authors.affiliation: Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Saint-Raymond
authors.affiliation: Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: S
authors.initials: S
authors.lastname: Quetant
authors.affiliation: Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Laboratoire de bioénergétique fondamentale et appliquée, Inserm 1055, 38400 Saint-Martin-d'Hères, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France.
authors.forename: C
authors.initials: C
authors.lastname: Pison
authors.affiliation: Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: E
authors.initials: E
authors.lastname: Lagrange
authors.affiliation: Pôle urgences médecine aiguë, clinique de réanimation médicale, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: R
authors.initials: R
authors.lastname: Hamidfar Roy
authors.affiliation: Service de pneumologie, hôpital Cantonal universitaire, Genève, Suisse.
authors.forename: J-P
authors.initials: JP
authors.lastname: Janssens
authors.affiliation: Pôle anesthésie réanimation, centre de la douleur, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Maindet-Dominici
authors.affiliation: Service de médecine intensive et de réanimation, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Garrouste-Orgeas
authors.affiliation: Unité mobile d'accompagnement et de soins palliatifs, hôpital universitaire Pitié-Salpêtrière, 75006 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Levy-Soussan
authors.affiliation: Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Pôle psychiatrie, neurologie et rééducation neurologique, clinique de neurologie, CHU de Grenoble, 38000 Grenoble, France; Inserm U1042, université Grenoble Alpes, HP2, CHU de Grenoble, 38000 Grenoble, France.
authors.forename: N
authors.initials: N
authors.lastname: Terzi
authors.affiliation: Pôle thorax et vaisseaux, clinique universitaire de pneumologie, CHU de Grenoble, 38000 Grenoble, France; Université Grenoble Alpes, 38400 Saint-Martin-d'Hères, France; Institut pour l'avancée des biosciences, centre de recherche UGA, Inserm U 1209, CNRS UMR 5309, 38000 Grenoble, France. Electronic address: AToffart@chu-grenoble.fr.
authors.forename: A-C
authors.initials: AC
authors.lastname: Toffart
mesh_terms: D002908:Chronic Disease; D003422:Critical Care / Q000706:statistics & numerical data*; D003657:Decision Making; D006801:Humans; D010166:Palliative Care / Q000379:methods*; D000070659:Patient Comfort / Q000379:methods; D011379:Prognosis; D012120:Respiration Disorders / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*
keywords: Amyotrophic lateral sclerosis; Bronchopneumopathie chronique obstructive; Cancer bronchopulmonaire; Chronic obstructive pulmonary disease; Fibrose pulmonaire idiopathique; Idiopathic pulmonary fibrosis; Lung cancer; Palliative care; Sclérose latérale amyotrophique; Soins palliatifs