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J Palliat Med. 2019 Mar;22(3):290-296. doi: 10.1089/jpm.2018.0363. Epub 2018 Nov 2.

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.

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1 Palliative Homecare Team Northern Area of Madrid, SERMAS , San Sebastian de los Reyes, Spain .
2 Palliative Care Department, La Paz Hospital , Madrid, Spain .
3 Pneumology Department, La Paz Hospital , Madrid, Spain .
4 Preventive Medicine, Public Health , SERMAS, San Sebastian de los Reyes, Spain .
5 Investigation Support Unit for Primary Care , Gerencia Atención Primaria, Madrid, Spain .
6 Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, Madrid, Spain.



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.


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.


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).


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.


ACP; end of life; palliative care; place of death; pulmonary disease chronic obstructive; quality of life

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