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Palliative care in COPD patients: is it only an end-of-life issue?
MedLine Citation:
PMID:  23204123     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The presence of acute or chronic respiratory failure is often seen as a terminal phase of chronic obstructive pulmonary disease. A great variability in end-of-life practice is observed in these patients mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues. Indeed, a perceived poor quality of life does not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. It has been suggested to start palliative care earlier, together with curative and restorative care, when there is an increased intensity of symptoms. The patients eligible for palliative care are those complaining of breathlessness, pain, fatigue and depression, which in some studies accounted for a prevalence much higher than 50%. Among comfort measures for palliation, oxygen is frequently prescribed even when the criteria for long-term home oxygen therapy are not met; however, when compared with air, no benefits on dyspnoea have been found. The only drug with a proven effect on dyspnoea is morphine, but not when it is delivered with a nebuliser. Finally, noninvasive ventilation may be used only as a comfort measure for palliation to maximise comfort by minimising adverse effects.
Authors:
Annalisa Carlucci; Aldo Guerrieri; Stefano Nava
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  European respiratory review : an official journal of the European Respiratory Society     Volume:  21     ISSN:  1600-0617     ISO Abbreviation:  Eur Respir Rev     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-03     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111391     Medline TA:  Eur Respir Rev     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  347-54     Citation Subset:  IM    
Affiliation:
Respiratory Unit, Fondazione S.Maugeri, IRCCS, Istituto Scientifico di Pavia, Pavia, and # Respiratory and Critical Care Unit, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
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