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End-of-life care for COPD is a team effort that aims to manage the patient’s symptoms and mental health and ensure they receive proper nutrition.
End-of-life care or palliative care focuses on improving the quality of life of patients with serious diseases, such as cancer and chronic obstructive pulmonary disease (COPD).
- Care emphasizes improving the physical and mental comfort of the patient, consequently making things easier for caregivers as well.
- Although used synonymously, palliative care does not necessarily mean end-of-life care or hospice. It simply means improving the social, mental, and physical health of a patient with an incurable disease.
Advanced COPD may make the patient feel drained, both physically and mentally. As the symptoms worsen, they need more than just medications.
Palliative care for COPD is provided as a team effort consisting of doctors, nurses, psychologists, dieticians, physiotherapists, and counselors or social workers who specialize in this type of care. Decisions are tailor-made in consultation with patients and their caregivers in a way that suits them the best.
Palliative care for COPD may consist of:
- Managing patient’s rest and physical activities:
- Advanced COPD may make even mild physical activity seem like an ordeal.
- The care team makes sure that the patient and caregivers understand the need of the patient to take adequate rest. Light physical activity may be facilitated to help the patient feel better while not putting extra stress on their lungs.
- The patient may need help with everything, including eating, drinking, personal hygiene, and even turning in bed. They may be wanting to sleep or stay in bed for longer durations. Their need for rest must be valued by the caregivers.
- Managing physical symptoms:
- The patient may have severe symptoms including cough, pain, and shortness of breath. These symptoms may interfere with proper sleep, rest, and even having conversations with loved ones. These symptoms may be managed with medications and physical therapy.
- Managing mental health:
- Patients with advanced COPD may experience considerable anxiety, fear, and other issues. This may make the disease seem even more difficult to cope with.
- With adequate counseling, support, and reassurance, patients with advanced COPD can have reasonably improved mental and emotional health. Moreover, caregivers may need counseling so that they can take care of their ailing loved one in the best way possible.
- Ensuring proper nutrition:
- Patients with advanced COPD may have difficulty eating due to their symptoms. The appetite may go considerably down as the disease progresses. Although seeing their loved ones starving may be an ordeal for caregivers, it's better to not force-feed them because it may cause them harm and make them more uncomfortable.
- The palliative care team can help caregivers with ensuring proper nutrition for their loved ones. Caregivers may provide their loved ones with small spoonfuls of soft foods or help them have a few sips of water to relieve any dryness or irritation in the mouth, improve urine output, improve digestive functions, relieve coughing and chest congestion.
- A few patients may need to be fed through a feeding tube.
End-of-life care is beneficial not only to patients but also to their caregivers. It helps them provide the best possible care to their loved ones and prepares them for impending grief or bereavement.
What are the stages of COPD?
Chronic obstructive pulmonary disease (COPD) is not a single disease but a group of lung diseases that tend to worsen with time, making breathing difficult. COPD affects over 16 million Americans and is the fourth leading cause of death.
COPD includes different diseases, but it is of three major types that include:
- Emphysema
- Chronic bronchitis
- Chronic obstructive asthma
All these diseases carry the common characteristic of causing progressive damage to the lungs that interferes with the flow of air through the airways. Based on the lab findings and severity of symptoms, COPD can be divided into different stages.
The COPD Foundation has a staging system that classifies COPD stages based on seven parameters:
- Spirometry (a type of test that measures lung functioning)
- Regular symptoms
- Number of exacerbations in the past year
- Oxygenation
- Computed tomography (CT) scan findings in the chest (emphysema on a CT scan)
- Presence of chronic bronchitis
- Other underlying health conditions (comorbidities)
The COPD Foundation classifies COPD into five stages:
- Stage 0: Normal spirometry
- Stage I: Mild disease
- Stage II: Moderate disease
- Stage III: Severe disease
- Stage U: Undefined
Another classification system categorizes COPD based on the symptoms and risk of exacerbations (flare-ups) such as:
- Group A: Minimally symptomatic, low risk of future exacerbations
- Group B: More symptomatic, low risk of future exacerbations
- Group C: Minimally symptomatic, high risk of future exacerbations
- Group D: More symptomatic, high risk of future exacerbations
A very popular staging system for COPD, called the Global Initiative for Chronic Obstructive Lung Disease (GOLD), classifies COPD based on symptoms and exacerbation history to plan appropriate treatment. It categorizes COPD into four stages:
- GOLD 1: Mild disease
- GOLD 2: Moderate disease
- GOLD 3: Severe disease
- GOLD 4: Very severe disease
What are the signs of end-of-life with COPD?
Stage IV chronic obstructive pulmonary disease (COPD) is also called the most advanced stage or end-stage COPD. The doctor will determine if a patient is in this stage based on their symptoms, examination, and certain investigations (particularly spirometry). During this stage, symptoms get quite bad and interfere with the patient’s daily life.
Symptoms of end-stage COPD include:
- Severe cough
- Severe shortness of breath or breathing difficulty that may make even simple tasks such as brushing teeth or having a meal difficult
- Crackling sounds on breathing
- Excessive mucus formation
- Wheezing
- Barrel-shaped chest
- Breathlessness even while at rest
- Confusion
- Drowsiness
- Appetite loss
- Weight loss
- Palpitations
End-stage or advanced COPD does not necessarily mean that the affected person won't survive for long. With appropriate treatment including lifestyle modification and chest physiotherapy, most people can live a productive and long life. Regular follow-up with the doctor greatly helps avoid flare-ups and helps the person have an improved quality of life.
