End-of-life care for patients with COPD in the community setting.

摘要

Chronic obstructive pulmonary disease (COPD) is a common chronic disease which causes significant mortality and morbidity. The chronic nature of the disease results in patients and carers generally living with the illness for longer than patients with a cancer diagnosis. In the earlier stages of the disease, management focuses on improving symptoms and exercise capacity and reducing exacerbations. As the disease progresses, a palliative care approach to symptom control and the adoption of strategies which accept dying as a normal process is appropriate. This should integrate the psychological and spiritual aspects of patient care and offer a support system to help patients live as actively as possible until death. Altering the paradigm to holistic palliative care as death approaches is supported in national guidance from bodies such as NICE, but defining when this should take place is difficult and in practice it is usually a gradual transition. As a large part of end-of-life care for patients with COPD occurs in the community, it falls to the primary healthcare team with the support of specialist palliative care and secondary care services to provide this integrated care.