palliative care and COPD
- related: COPD chronic obstructive pulmonary disease
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Prognosis and Goals of Care
The current GOLD initiative recommends combining the degree of airflow limitation using the post-bronchodilator FEV1 with the number of exacerbations and the patient's symptoms to classify the severity of disease. This will allow the clinician to guide escalation or de-escalation of medical therapies as appropriate.
The BODE index can be used as a prognostic indicator for patients with COPD. Using the BMI, the post-bronchodilator FEV1 percent of predicted, dyspnea as defined using the mMRC scale (see Table 6), and the distance walked on a 6-minute walk test, it is possible to approximate the patient's 4-year survival. In patients with severe disease with an overall poor prognosis, referral for hospice and palliative care can provide significant improvements in symptom burden.
Palliative care can significantly aid in symptom management in patients with COPD at any stage of disease. Patients experience not only dyspnea, but also anxiety and depression, which may also be addressed. Opioids are commonly used to treat dyspnea that persists despite medical therapy. Current guidelines suggest a patient with severe COPD — defined by disabling symptoms despite medical therapy, progression of disease as evidenced by increasing emergency department evaluations or hospitalizations, and hypoxemia or hypercapnia — should be considered for hospice care.