Journal of Hospice and Palliative Care

Korean Society for Hospice and Palliative Care (한국호스피스완화의료학회)
권호 표지
DOI QR코드

DOI QR Code

Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease

만성 폐쇄성 폐질환의 호스피스 완화의료

  • Shin, Jinyoung (Department of Family Medicine, Yonsei University College of Medicine) ;
  • Park, Hye Yun (Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jungkwon (Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 신진영 ;
  • 박혜윤 (성균관대학교 의과대학, 삼성서울병원 내과학교실 호흡기내과) ;
  • 이정권 (성균관대학교 의과대학, 삼성의료원 암치유센터)
  • Received : 2016.07.21
  • Accepted : 2017.05.30
  • Published : 2017.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation that is usually progressive. It is a major cause of morbidity and mortality worldwide, leading to substantial and increasing economic and social burden. Palliative care for COPD patients aims to reduce symptoms and exacerbations and improve exercise tolerance and quality of life. It is difficult to make a prognosis for COPD patients due to the variable illness trajectory and advanced care of patients. However, severity of breathlessness, assessment of lung function impairment, and frequency of exacerbations can help to identify palliative care needs and determine effective methods to mitigate symptoms, which is discussed in this paper. In these patients, it is recommended to provide individualized palliative care along with curative/restorative care at the onset of COPD symptoms. Before launching a palliative care system in Korea, it is necessary to prepare pulmonary rehabilitation resources, patient-centered communication, timely palliative responsiveness, and a program for effective advanced care planning. A multidisciplinary approach involving collaboration with not only the respiratory and palliative care teams but also primary care offers a new model of care for these patients and should be considered with a priority.

만성 폐쇄성 폐질환은 비가역적, 점진적 기도 폐쇄가 특징인 주요 사망 원인중의 하나이다. 말기 폐쇄성 폐질환 환자는 다양한 신체적, 정서적, 사회적, 기능적 문제로 인해 호스피스 완화의료가 필요하다. 따라서, 완화의료의 목적은 증상 조절, 운동 능력 및 삶의 질 향상이며, 아울러 급성 악화 빈도를 줄이고 질병의 진행을 늦추는 효과를 기대할 수 있다. 다양한 진행 과정 때문에 말기 시점을 예측하기 어렵다. 호흡곤란 정도, 폐기능, 혈액학적 임상 지표를 이용하여 대상자를 선정하는 기준을 마련하고 적용시점을 논의해야 한다. 질환의 특성상 진단 후 초기에는 완치 목적의 치료가 중심이 되어 완화의료가 이를 보완하는 방식으로 적용되다가, 완치 목적의 치료를 위해 입 퇴원을 반복하거나 치료의 반응이 낮고 나쁜 예후가 예상될 때 완화의료 비중이 확대되는 것이 바람직하겠다. 폐쇄성 폐질환 환자에게 적극적으로 호흡재활을 적용하고, 환자의 의사결정을 존중하여 증상 악화 이전에 미리 대책을 마련하고 앞으로의 치료 목표를 논의하기 위한 완화의료 팀을 구성하고, 국내 현실에 맞는 진료 연계 체계를 마련하는 것이 필요하다. 제도가 잘 정착하기 위해서는 일차 의료 및 암환자 대상의 완화의료 전문 팀과의 협업이 중요하며, 우선 고려되어야 할 것이다.

Keywords

References

  1. Seamark DA, Seamark CJ, Halpin DM. Palliative care in chronic obstructive pulmonary disease: a review for clinicians. J R Soc Med 2007;100:225-33. https://doi.org/10.1177/014107680710000512
  2. GOLD: Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease [Internet]. [Place of publication not identified]: Global Initiative for Chronic Obstructive Lung Disease; c2016 [updated 2016; cited 2016 Jul 1]. Available from: http://www.goldcopd.org.
  3. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2006;3:e442. https://doi.org/10.1371/journal.pmed.0030442
  4. KCDC: 2015 The prevalance of chronic obstructive pulmonary disease [Internet]. Cheongju: Division of Health & Nutrtition Survey, Centers for Disease Control & Prevention; 2016 [cited 2016 Jul 1]. Available from: https://knhanes.cdc.go.kr/knhanes/index.do.
  5. U.S. Department of Health and Human Services, Public Health Service, Office of the Surgeon Genernal. The health consequences of smoking-50 years of progress: a report of the Surgeon General. Atlanta, GA.:U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health;2014.
  6. Yoo KH. Smoking cessation and chronic obstructive pulmonary disease. Korean J Intern Med 2015;30:163-6. https://doi.org/10.3904/kjim.2015.30.2.163
  7. Barnes PJ, Celli BR. Systemic manifestations and comorbidities of COPD. Eur Respir J 2009;33:1165-85. https://doi.org/10.1183/09031936.00128008
  8. Au DH, Udris EM, Fihn SD, McDonell MB, Curtis JR. Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med 2006;166:326-31. https://doi.org/10.1001/archinte.166.3.326
  9. Rocker G, Horton R, Currow D, Goodridge D, Young J, Booth S. Palliation of dyspnoea in advanced COPD: revisiting a role for opioids. Thorax 2009;64:910-5. https://doi.org/10.1136/thx.2009.116699
  10. Zhou HX, Ou XM, Tang YJ, Wang L, Feng YL. Advanced Chronic Obstructive Pulmonary Disease: Innovative and Integrated Management Approaches. Chin Med J (Engl) 2015;128:2952-9. https://doi.org/10.4103/0366-6999.168073
  11. Weingaertner V, Scheve C, Gerdes V, Schwarz-Eywill M, Prenzel R, Bausewein C, et al. Breathlessness, functional status, distress, and palliative care needs over time in patients with advanced chronic obstructive pulmonary disease or lung cancer: a cohort study. J Pain Symptom Manage 2014;48:569-81.e1. https://doi.org/10.1016/j.jpainsymman.2013.11.011
  12. Ostgathe C, Alt-Epping B, Golla H, Gaertner J, Lindena G, Radbruch L, et al. Non-cancer patients in specialized palliative care in Germany: what are the problems? Palliat Med 2011;25:148-52. https://doi.org/10.1177/0269216310385370
  13. van der Eerden M, Csikos A, Busa C, Hughes S, Radbruch L, Menten J, et al. Experiences of patients, family and professional caregivers with Integrated Palliative Care in Europe: protocol for an international, multicenter, prospective, mixed method study. BMC Palliat Care 2014;13:52. https://doi.org/10.1186/1472-684X-13-52
  14. Hess S, Stiel S, Hofmann S, Klein C, Lindena G, Ostgathe C. Trends in specialized palliative care for non-cancer patients in Germany--data from the national hospice and palliative care evaluation (HOPE). Eur J Intern Med 2014;25:187-92. https://doi.org/10.1016/j.ejim.2013.11.012
  15. Rosenwax L, Spilsbury K, McNamara BA, Semmens JB. A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on? BMC Palliat Care 2016;15:46. https://doi.org/10.1186/s12904-016-0119-2
  16. Bettoncelli G, Blasi F, Brusasco V, Centanni S, Corrado A, De Benedetto F, et al. The clinical and integrated management of COPD. An official document of AIMAR (Interdisciplinary Association for Research in Lung Disease), AIPO (Italian Association of Hospital Pulmonologists), SIMER (Italian Society of Respiratory Medicine), SIMG (Italian Society of General Medicine). Multidiscip Respir Med 2014;9:25. https://doi.org/10.1186/2049-6958-9-25
  17. West E, Pasman HR, Galesloot C, Lokker ME, Onwuteaka-Philipsen B; EURO IMPACT. Hospice care in the Netherlands: who applies and who is admitted to inpatient care? BMC Health Serv Res 2016;16:33.
  18. Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med 2014;2:979-87. https://doi.org/10.1016/S2213-2600(14)70226-7
  19. Korean Academy of Medical Sciences. The standardization of definition for end of life and the last days of life [Internet]. Seoul: Korean Academy of Medical Sciences; 2016. [cited 2017 Apr 20]. Availble from: http://hospice.cancer.go.kr/hospice/front/boardView.do?keykind=&keyword=&page_now&returl=/front/boardList.do&listurl=/front/boardList.do&brd_mgrno=181&menu_n o=442&brd_no=88471.
  20. Lanken PN, Terry PB, Delisser HM, Fahy BF, Hansen-Flaschen J, Heffner JE, et al. An Official American Thoracic Society Clinical Policy Statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008;177:912-27. https://doi.org/10.1164/rccm.200605-587ST
  21. Dalgaard KM, Bergenholtz H, Nielsen ME, Timm H. Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome. Palliat Support Care 2014;12:495-513. https://doi.org/10.1017/S1478951513001338
  22. Siouta N, van Beek K, Preston N, Hasselaar J, Hughes S, Payne S, et al. Towards integration of palliative care in patients with chronic heart failure and chronic obstructive pulmonary disease: a systematic literature review of European guidelines and pathways. BMC Palliat Care 2016;15:18. https://doi.org/10.1186/s12904-016-0089-4
  23. Blinderman CD, Homel P, Billings JA, Tennstedt S, Portenoy RK. Symptom distress and quality of life in patients with advanced chronic obstructive pulmonary disease. J Pain Symptom Manage 2009;38:115-23. https://doi.org/10.1016/j.jpainsymman.2008.07.006
  24. Weingartner V, Scheve C, Gerdes V, Schwarz-Eywill M, Prenzel R, Otremba B, et al. Characteristics of episodic breathlessness as reported by patients with advanced chronic obstructive pulmonary disease and lung cancer: Results of a descriptive cohort study. Palliat Med 2015;29:420-8. https://doi.org/10.1177/0269216314563428
  25. Vestbo J, Anderson JA, Calverley PM, Celli B, Ferguson GT, Jenkins C, et al. Adherence to inhaled therapy, mortality and hospital admission in COPD. Thorax. 2009;64:939-43. https://doi.org/10.1136/thx.2009.113662
  26. Rocker G, Horton R, Currow D, Goodridge D, Young J, Booth S. Palliation of dyspnoea in advanced COPD: revisiting a role for opioids. Thorax 2009;64:910-5. https://doi.org/10.1136/thx.2009.116699
  27. National Clinical Guideline Centre. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonaty disease in adults in primary and secondary care [Internet]. London: Royal College of Physicians (UK); 2010. National Institute for Health and Clinical Excellence. NICE Clinical Guidelines, No. 101. [updated 2016 Jun; cited 2016]. Available from: https://www.nice.org.uk/guidance/cg101/resources/chronic-obstructive-pulmonary-disease-update-full-guideline2.
  28. Albert RK, Connett J, Bailey WC, Casaburi R, Cooper JA Jr, Criner GJ, et al. Azithromycin for prevention of exacerbations of COPD. N Engl J Med 2011;365:689-98. https://doi.org/10.1056/NEJMoa1104623
  29. Martinez FJ, Calverley PM, Goehring UM, Brose M, Fabbri LM, Rabe KF. Effect of roflumilast on exacerbations in patients with severe chronic obstructive pulmonary disease uncontrolled by combination therapy (REACT): a multicentre randomised controlled trial. Lancet 2015;385:857-66. https://doi.org/10.1016/S0140-6736(14)62410-7
  30. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive lung disease: a clinical trial. Nocturnal Oxygen Therapy Trial Group. Ann Intern Med 1980;93:391-8. https://doi.org/10.7326/0003-4819-93-3-391
  31. Han KT, Kim SJ, Park EC, Yoo KB, Kwon JA, Kim TH. Does home oxygen therapy slow down the progression of chronic obstructive pulmonary diseases? Korean J Hosp Palliat Care 2015;18:128-35. https://doi.org/10.14475/kjhpc.2015.18.2.128
  32. Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE. A systematic review of the use of opioids in the management of dyspnoea. Thorax 2002;57:939-44. https://doi.org/10.1136/thorax.57.11.939
  33. Varkey B. Opioids for palliation of refractory dyspnea in chronic obstructive pulmonary disease patients. Curr Opin Pulm Med 2010;16:150-4. https://doi.org/10.1097/MCP.0b013e3283364378
  34. Heffner JE. Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities. Curr Opin Pulm Med 2011;17:103-9. https://doi.org/10.1097/MCP.0b013e328341ce80
  35. Hardin KA, Meyers F, Louie S. Integrating palliative care in severe chronic obstructive lung disease. COPD 2008;5:207-20. https://doi.org/10.1080/15412550802237366
  36. Creutzberg EC, Wouters EF, Mostert R, Weling-Scheepers CA, Schols AM. Efficacy of nutritional supplementation therapy in depleted patients with chronic obstructive pulmonary disease. Nutrition 2003;19:120-7. https://doi.org/10.1016/S0899-9007(02)00841-9
  37. Leuppi JD, Schuetz P, Bingisser R, Bodmer M, Briel M, Drescher T, et al. Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. JAMA 2013;309:2223-31. https://doi.org/10.1001/jama.2013.5023
  38. IMPRESS guide for commissioners on supportive and end of life care for people with COPD. London;Warwickshire: British Thoracic Society and Primary Care Respiratory Society UK;2012.
  39. Mas A, Masip J. Noninvasive ventilation in acute respiratory failure. Int J Chron Obstruct Pulmon Dis 2014;9:837-52.
  40. Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax 2000;55:1000-6. https://doi.org/10.1136/thorax.55.12.1000
  41. Sillen MJ, Franssen FM, Delbressine JM, Vaes AW, Wouters EF, Spruit MA. Efficacy of lower-limb muscle training modalities in severely dyspnoeic individuals with COPD and quadriceps muscle weakness: response from the authors. Thorax 2014;69:953-4.
  42. Downar J, Delaney JW, Hawryluck L, Kenny L. Guidelines for the withdrawal of life-sustaining measures. Intensive Care Med 2016;42:1003-17. https://doi.org/10.1007/s00134-016-4330-7
  43. Connors AF Jr, Dawson NV, Thomas C, Harrell FE Jr, Desbiens N, Fulkerson WJ, et al. Outcomes following acute exacerbation of severe chronic obstructive lung disease. The SUPPORT investigators (Study to Understand Prognoses and Preferences for Outcomes and Risks of Treatments). Am J Respir Crit Care Med 1996;154(4 Pt 1):959-67. https://doi.org/10.1164/ajrccm.154.4.8887592
  44. Hoogendoorn M, Hoogenveen RT, Rutten-van Molken MP, Vestbo J, Feenstra TL. Case fatality of COPD exacerbations: a meta-analysis and statistical modelling approach. Eur Respir J 2011;37:508-15. https://doi.org/10.1183/09031936.00043710
  45. Roberts CM, Lowe D, Bucknall CE, Ryland I, Kelly Y, Pearson MG. Clinical audit indicators of outcome following admission to hospital with acute exacerbation of chronic obstructive pulmonary disease. Thorax 2002;57:137-41. https://doi.org/10.1136/thorax.57.2.137
  46. Glaudemans JJ, Moll van Charante EP, Willems DL. Advance care planning in primary care, only for severely ill patients? A structured review. Fam Pract 2015;32:16-26. https://doi.org/10.1093/fampra/cmu074
  47. Roberts JE, Reid MC, Adelman RD. Palliative care interventions in advanced chronic diseases: A systematic review. J Am Geriatr Soc 2012;60(s4):S226.
  48. Rocker GM, Simpson AC, Horton R. Palliative care in advanced lung disease: The challenge of integrating palliation Into everyday care. Chest 2015;148:801-9. https://doi.org/10.1378/chest.14-2593
  49. Croft M. Palliative care in end-stage COPD. Br J Gen Pract 2005;55:234.
  50. Curtis JR. Palliative and end-of-life care for patients with severe COPD. Eur Respir J 2008;32:796-803. https://doi.org/10.1183/09031936.00126107
  51. Curtis JR, Wenrich MD, Carline JD, Shannon SE, Ambrozy DM, Ramsey PG. Patients' perspectives on physician skill in end-of-life care: differences between patients with COPD, cancer, and AIDS. Chest 2002;122:356-62. https://doi.org/10.1378/chest.122.1.356
  52. Gaber KA, Barnett M, Planchant Y, McGavin CR. Attitudes of 100 patients with chronic obstructive pulmonary disease to artificial ventilation and cardiopulmonary resuscitation. Palliat Med 2004;18:626-9. https://doi.org/10.1191/0269216304pm944oa
  53. Carlucci A, Vitacca M, Malovini A, Pierucci P, Guerrieri A, Barbano L, et al. End-of-life discussion, patient understanding and determinants of preferences in very severe COPD patients: A multicentric study. Copd 2016;13:632-8. https://doi.org/10.3109/15412555.2016.1154034
  54. Fromer L. Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes. Int J Chron Obstruct Pulmon Dis 2011;6:605-14.
  55. Ouwens M, Wollersheim H, Hermens R, Hulscher M, Grol R. Integrated care programmes for chronically ill patients: a review of systematic reviews. Int J Qual Health Care 2005;17:141-6. https://doi.org/10.1093/intqhc/mzi016
  56. Garralda E, Hasselaar J, Carrasco JM, Van Beek K, Siouta N, Csikos A, et al. Integrated palliative care in the Spanish context: a systematic review of the literature. BMC Palliat Care 2016;15:49. https://doi.org/10.1186/s12904-016-0120-9

Cited by

  1. Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014 vol.21, pp.1, 2018, https://doi.org/10.14475/kjhpc.2018.21.1.23
  2. Life-Sustaining Procedures, Palliative Care Consultation, and Do-Not Resuscitate Status in Dying Patients With COPD in US Hospitals : 2010-2014 vol.33, pp.3, 2018, https://doi.org/10.1177/0825859718777375
  3. 만성 심폐질환을 가진 말기 노인환자의 연명의료결정 전후 완화간호의 제공 vol.11, pp.1, 2021, https://doi.org/10.22156/cs4smb.2021.11.01.045