Hansen-Flaschen J. Chronic obstructive pulmonary disease: the last year of life. Respir Care. 2004;49:90-8.
This review article discusses terminal care for patients with chronic obstructive pulmonary disease (COPD). Several factors including: severe, irreversible airflow obstruction, severely impaired and declining exercise capacity and performance status, older age, concomitant cardiovascular or other co-morbid disease, and a history of recent hospitalizations for acute care, suggest a six to twelve month life expectancy. The author concludes that the attending physician should initiate medical advance planning with patients manifesting these characteristics in a 3-way conversation between patient, health care proxy, and physician an during a prescheduled out-patient office visit. This should result in an advance directive summarize and documenting the conversation. Hospice care is appropriate when a COPD patient is at high risk of respiratory failure from the next chest infection and in need of frequent or specialized home care. Other issues include a realistic appraisal of the prospects for dying peacefully at home and a contingency plan for terminal hospitalization, should the need arise. This article is longer on compassion and common sense that science but is useful for primary care physicians and pulmonary specialists caring for patients with severe COPD when the goal of treatment is a good death.
