palliative care in end-stage COPD
Last edited 02/2021 and last reviewed 11/2022
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Therapy relevant to all patients with COPD:
- palliative treatment for dyspnoea (1):
- opiates, neuromuscular electrical stimulation (NMES), chest wall vibration (CWV) and fans blowing air onto the face can help in breathlessness
- immediate-release morphine extended exercise endurance time in over half of patients with advanced COPD, although further research is required to determine what patient characteristics predict response
- oygen may offer some benefit even if the patient is not hypoxemic (Sp02 > 92%)
- pulmonary rehabilitation is effective and in severe cases non-invasive ventilation can also reduce daytime breathlessness
- acupuncture and acupressure are other non-pharmacological approaches in patients with advanced COPD that may improve breathlessness and quality of life
- refractory dyspnea may be more effectively managed with a multidisciplinary integrated palliative and respiratory care service
- is no evidence for a beneficial effect of benzodiazepines
- nutritional support
- if a COPD patient is malnourished, then nutritional supplementation to gain weight will lead to significant improvements in respiratory muscle strength and overall health-related quality of life
- cognitive behavioural therapy and mind body interventions (yoga, relaxation etc) may help in reducing anxiety and depression
Patients with end-stage COPD and their family and carers should have access to the full range of services offered by multidisciplinary palliative care teams, including admission to hospices
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