Pulmonary rehabilitation and palliative care in COPD: Two sides of the same coin?

Abstract

Pulmonary rehabilitation and palliative care are two important components of the integrated care of the patient with chronic respiratory disease such as chronic obstructive pulmonary disease (COPD). These two interventions are remarkably similar in many respects. Both utilize a multidisciplinary team that focuses on the specific needs of the individual patient. Care in both is goal defined and includes relief of symptoms and improvements in functional status and quality of life. Pulmonary rehabilitation is commonly given in a specific setting, such as a hospital-based outpatient setting, while palliative care is often hospital based, with its services extending into the home setting in the form of hospice. Components of pulmonary rehabilitation and palliative care should be administered as part of good medical care. Both pulmonary rehabilitation and palliative care are currently underutilized in the respiratory patient, and often provided relatively late in the patient's clinical course. The case provided illustrates the often-overwhelming symptom burden of advanced COPD and demonstrates opportunities for the application of these twin interventions.

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

“…The majority of studies published focussed on patients with COPD (n=24) 4, in addition to multi-disease diagnoses studies (n=10) 1,5,[30][31][32][33][34][35][36][37] where the majority of patients in the study sample had a diagnosis of COPD. Patients with cancer diagnoses were the next studied population of focus (n=13), [38][39][40][41][42][43][44][45][46][47][48][49][50] followed by patients with interstitial lung disease (n=8), [51][52][53][54][55][56][57][58] and lastly one study focussed on patients with Huntington's disease (Table 1) Page S35…”

“…Examples include: patients attributing their symptoms to a natural case of "getting older" and therefore do not seek help, a patient holds a belief that there are no treatments available to improve their situation, or a patient may have guilt for causing their condition, fear they will be judged and blamed for their condition and therefore do not deserve or seek treatment. 4,15,16 One study showed that patients with COPD admitted to having dyspnea severe enough to disrupt their lives and accepted this as a normal part of life rather than as a consequence of the disease. 4 Patients also identified distance as a barrier to participating in pulmonary rehabilitation including transportation to and from and the associated cost in getting to the hospital.…”

“…4,15,16 One study showed that patients with COPD admitted to having dyspnea severe enough to disrupt their lives and accepted this as a normal part of life rather than as a consequence of the disease. 4 Patients also identified distance as a barrier to participating in pulmonary rehabilitation including transportation to and from and the associated cost in getting to the hospital. 21 Another barrier appears to be a lack of education in the general population as to what COPD is and the time course of the disease.…”

“…Pulmonary rehabilitation is usually hospital-based and focuses on exercise, promotion of health behaviours, and raising functional status. 4 Physiotherapists, respiratory therapists, and other pulmonary rehabilitation health providers can show patients physical exercises, positioning, and breathing exercises so that the patients themselves can take an active role in symptom management. Often as the disease progresses, patients experience mixed emotions.…”

Danish respiratory society position paper: palliative care in patients with chronic progressive non-malignant lung diseases

“…Rehabilitation is expected to result in improved symptom control and functional capacity, and thus improved overall QOL [20]. Rehabilitation should be offered to all patients with symptomatic chronic lung diseases, even to those in the terminal phase of the disease [18].…”