Most patients with COPD die during acute exacerbations; in those who have been treated with acute NIV, almost 80% will require admission in the following year.
A comprehensive management plan for endstage lung disease patients needs to address symptom burden, provide information, support carers and assist with end-of-life planning.
Management should include optimisation of treatment of airflow obstruction and pulmonary rehabilitation. In some patients, pharmacotherapy for dyspnoea, panic attacks, depression and insomnia have a key role, but the importance of practical measures, including stairlifts, bath aids and social support, should not be underestimated.
Advance directives enable patients to give direction to the medical team about treatment preferences and should be part of routine care, especially in individuals who have already experienced an acute hypercapnic exacerbation.
To raise awareness of the symptom load of end-stage lung disease.
To examine trajectories of end-stage disease.
To discuss treatment strategies.
Summary Individuals with end-stage lung disease have a substantial symptom burden, which is often poorly addressed compared to patients with malignant disease. Recognition of the disease trajectory in the last few years of life enables a symptom-based approach that combines palliative care with active treatment of exacerbations where appropriate. Discussion of advance directives is helpful for both the patient and the physician.
- ©ERS 2006
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