Palliative care for people with COPD: effective but underused

Abstract

@ERSpublications Despite its effectiveness palliative care is underused in the majority of patients with COPD http://ow.ly/d0YH30hPKeuCite this article as: Halpin DMG. Palliative care for people with COPD: effective but underused. Eur Respir J 2018; 51: 1702645 [https://doi.org/10.1183/13993003.02645-2017.Nearly 100 000 men and over 65 000 women die from chronic obstructive pulmonary disease (COPD) in Europe each year [1]; more die from one of its comorbidities but face the challenges of living and dying with severe COPD during their last years and months. Globally, COPD is the third most common cause of death worldwide and the Global Burden of Disease project estimated that, in 2015, COPD caused 3.2 million deaths, an increase of 11.6% compared with 1990 [2].For the people that die of, or with, COPD, their final months are often characterised by a progressive decline in health status, increasing symptoms and increased reliance on family and carers to perform simply daily activities such as washing and dressing. Despite this burden of disease, the vast majority of patients with advanced COPD are not offered palliative care, an approach that centres on the management of symptoms, maintaining quality of life and good communication. The underuse of palliative care was first reported nearly 20 years ago [3] and, since then, national and international guidelines have tried to encourage its adoption. The importance and benefits of palliative care were emphasised in the National Institute for Health and Care Excellence (NICE) COPD guideline in the UK published in 2004 [4] and in the American Thoracic Society/European Respiratory Society position paper published the same year [5]. In the UK, the Department of Health also introduced an "End of Life Care Strategy" in 2008 which was a comprehensive framework aimed at promoting high quality care across the country for all adults approaching the end of life [6]. Against this background, it is particularly disappointing that the study by BLOOM et al. [7], published in this issue of the European Respiratory Journal, shows that between 2004 and 2015 only one in five people dying from COPD in the UK were recorded as having received any palliative care. Just under half of those that did get palliative care only received it during the last 6 months of their life and one third only in their last month of life. There was a progressive increase in the use of palliative care over the decade, indicating that awareness and use of palliative care in COPD is changing, but it is clear that palliative care is still much more likely to be used in people with cancer as in the study people with COPD and lung cancer were 40% more likely to be offered palliative care than those with COPD alone. A strength of the study is the large number of patients included from the Clinical Practice Research Datalink which covers 674 UK primary care practices, with representative demographics; however, the analysis does depend on practitioners having specifically documented the use of palliative care using on...

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