Palliative care understanding and end-of-life decisions in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is one of the leading causes of respiratory morbidity and mortality with limited data on palliative care and evidence of reluctance to end-of-life discussions.

The primary objective of this study was to evaluate the understanding of palliative care as an option in COPD. Moreover, we wanted to identify any barriers to resuscitation discussions in this group of patients.

We developed a questionnaire addressing the aims of the study. Patients with COPD were prospectively recruited into the study and completed palliative questionnaire, Leicester cough questionnaire, Borg dyspnoea index and Medical Research Council dyspnoea scale.

The patient population was predominantly male (60%) with mean age of 70 years (range 43-87 years). The mean forced expiratory volume in 1 s was 1.0 (range 0.3-2.3 L). The mean body mass index of the cohort was 24.3 (standard deviation 6.7, range 14.5-42). Ten patients (33%) were on home oxygen. Thirteen (43%) patients understood the term non-invasive ventilation, and 11 of those would consider it again if needed. Only 13% of patients knew that palliative care is an option in COPD. Eleven patients understood the term cardiopulmonary resuscitation, and only five (16%) ever had a discussion regarding resuscitation.

This study demonstrates that there is extremely limited awareness of palliative care in patients with COPD. Moreover, the barriers to the end-of-life discussions should be explored to improve the end-of-life care in this disease.