Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements

Abstract

Background and Aim: Consensus has been reached on the need to integrate palliative care in the follow-up examinations of chronic obstructive pulmonary disease (COPD) patients. We analyzed the survival from the initiation of follow-up by a palliative home care team (PHCT) and described the needs and end-of-life process. Setting and Design: This study was a prospective observational cohort study of advanced COPD patients referred to a PHCT. Sociodemographic variables, survival from the start date of follow-up using the Kaplan–Meier model, health resource consumption, perceived quality of life, main symptomatology, opioid use, and advanced care planning (ACP) were analyzed. Results: Sixty patients were included. The median survival was 8.3 months. Forty-two patients died at the end of the study (85% at home or in palliative care units). The most frequent cause of death was respiratory failure in 39 patients (93%), with 29 of these patients requiring sedation (69%). Dyspnea at rest, with an average of 5 (standard deviation [SD] 2) points, was the main symptom. Fifty-five patients (91%) required opioids for symptom control. The median score in the St. George's Respiratory Questionnaire was 72 (SD 13). The mean number of visits by the home team was 7 (SD 6.5). The mean number of admissions during the monitoring period was 1.5 (SD 0.15). Conclusions: The characteristics of the cohort appear suitable for a PHCT. The follow-up care provided by our multidisciplinary unit decreased the number of hospitalizations, favored the development of ACP, and enabled death at home or in palliative care units.

Survival and end-of-life aspects among subjects on long-term noninvasive ventilation

“…Many of the subjects in this study died in the hospital, and only one-fifth of them died at home, which was also found in a study by Gruneir et al [ 31 ]. In contrast, 85% of the 60 patients with advanced COPD died at home or in the palliative care unit in a recent study by Gainza-Miranda et al, highlighting the different practices in the arrangements of palliative care in the context of advanced respiratory insufficiency [ 32 ]. In addition, almost half of the subjects arrived via the emergency room for their last hospitalization prior to death in our study.…”

Palliative Sedation at the End of Life: A Comparative Study of Chronic Obstructive Pulmonary Disease and Lung Cancer Patients

“…Although our results do not allow us to identify the causes of this association, one might speculate whether it is due to the selection of patients with more intense and refractory symptoms or whether it simply reflects patients who have had previous palliative care, anticipating the conversation about decisions to be made in the final phase of life. In fact, in a cohort of 60 patients with terminal COPD enrolled in a home hospice program in our setting, 69% received PS [43].…”

Dyspnea on Exercise Is Associated with Overall Symptom Burden in Patients with Chronic Respiratory Insufficiency

“…Dyspnea, which may occur with or without respiratory insufficiency, is a subjective experience of breathing discomfort, 1 whereas chronic respiratory insufficiency is an objective finding defined by hypoxemia (partial pressure of oxygen in arterial gas <8.0 kPa) or hypercapnia (partial pressure of carbon dioxide in blood gas ‡6.0 kPa) caused by disturbance of gas exchange between pulmonary alveoli and circulation or by insufficient ventilation. 2 Patients with advanced COPD or ILD typically suffer from severe dyspnea, [3][4][5] which increases with approaching death and is associated with impaired quality of life. [6][7][8] In addition to dyspnea, patients with COPD and ILD suffer frequently from other symptoms, such as fatigue, weight loss, depression, and anxiety, further impairing their quality of life.…”