Palliative care and management principles in older patients with advanced chronic obstructive pulmonary disease

摘要

Advanced chronic obstructive pulmonary disease (COPD) patients are likely to develop comorbidities that may contribute to a substantial burden of symptoms such as intolerable dyspnea, fatigue and poor-health status. Evidence from the available literature suggests that advanced COPD patients are less likely to receive palliative care and/or supportive care compared with cancer patients. Factors that contribute to this disparity are multifactorial, including diagnostic uncertainty of when to provide palliative care, patients' unwillingness to discuss advanced care planning with their general practitioners, lack of appropriate guidelines regarding when to refer patients to palliative care and lack of adequate resources. A few unblinded studies of palliative-care provision that included advanced COPD patients with other life-threatening diseases demonstrated some benefits in reducing healthcare utilization, improving quality of life and greater patient and caregiver satisfaction with the service. Therefore, further studies are required employing randomized controlled trials to show the benefits of a patient-centred multidisciplinary palliative care program and its cost-effectiveness for this patient group.