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Br J Gen Pract. 2011 Jun;61(587):e362-70. doi: 10.3399/bjgp11X578043.

Palliative care or end-of-life care in advanced chronic obstructive pulmonary disease: a prospective community survey.

Author information

  • 1Department of General Practice and Primary Care, King's College London, UK. patrick.white@kcl.ac.uk

Abstract

BACKGROUND:

Calls for better end-of-life care for advanced chronic obstructive pulmonary disease (COPD) reflect the large number who die from the disease and their considerable unmet needs.

AIM:

To determine palliative care needs in advanced COPD.

DESIGN:

Cross-sectional interview study in patients' homes using structured questionnaires generated from 44 south London general practices.

METHOD:

One hundred and sixty-three (61% response) patients were interviewed, mean age 72 years, 50% female, with diagnosis of COPD and at least two of: forced expiratory volume in the first second (FEV(1)) <40% predicted, hospital admissions or acute severe exacerbations with COPD, long-term oxygen therapy, cor pulmonale, use of oral steroids, and being housebound. Patients with advanced cancer, severe alcohol-related or mental health problems, or learning difficulties, were excluded; 145 patients were included in the analysis.

RESULTS:

One hundred and twenty-eight (88%) participants reported shortness of breath most days/every day, 45% were housebound, 75% had a carer. Medical records indicated that participants were at least as severe as non-participants. Eighty-two (57%) had severe breathlessness; 134 (92%) said breathlessness was their most important problem; 31 (21%) were on suboptimal treatment; 42 (30%) who were severely affected had not been admitted to hospital in the previous 2 years; 86 of 102 who had been admitted would want admission again if unwell to the same extent. None expressed existential concerns and few discussed need in terms of end-of-life care, despite severe breathlessness and impairment.

CONCLUSION:

Needs in advanced COPD were considerable, with many reporting severe intractable breathlessness. Palliation of breathlessness was a priority, but discussion of need was seldom in terms of 'end-of-life care'.

PMID:
21801516
[PubMed - indexed for MEDLINE]
PMCID:
PMC3103700
Free PMC Article
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