The experience of breathlessness: the social course of chronic obstructive pulmonary disease

Update on the role of palliative oxygen

PURPOSE OF REVIEW

Breathlessness remains a frequent and burdensome symptom for individuals with life-limiting symptoms in both malignant and nonmalignant settings. As oxygen therapy is frequently given as part of the management of breathlessness and is associated with costs, treatment burden and potential dangers, it is timely to review the efficacy and appropriateness of palliative oxygen therapy.

RECENT FINDINGS

Despite the widespread use of oxygen therapy in clinical and community settings, data supporting this approach is sparse. The benefits of long-term oxygen therapy for severely hypoxaemic people with chronic obstructive pulmonary disease are proven; however, mounting evidence suggests that oxygen does not confer additional benefit over medical air for the relief of refractory breathlessness in people with mild or absent hypoxaemia.

SUMMARY

On the basis of the findings of this review, the routine use of palliative oxygen therapy without detailed assessment of pathogenesis and reversibility of symptoms cannot be justified. Promoting self-management strategies, such as cool airflow across the face, exercise and psychological support for patients and carers, should be considered before defaulting to oxygen therapy. If palliative oxygen therapy is considered for individuals with transient or mild hypoxaemia, a therapeutic trial should be conducted with clinical review after 3 days to assess the net clinical benefit and patient preference.

Patients' experiences of health transitions in pulmonary rehabilitation

People who live with chronic obstructive pulmonary disease (COPD) experience major changes in health. Coping with the illness and caring for themselves places extensive demands on them. Thus, pulmonary rehabilitation (PR) is recommended as a means to facilitate healthy transitions in everyday life with COPD. This study explores the experience of patients with COPD in terms of their transitions in health during and after PR. The research was inspired by interpretive phenomenology. Thirty-three individual qualitative interviews were conducted with eighteen patients recruited from Norwegian PR units. A thematic analysis of the interviews was performed. The interviewees described participation in PR as a time of increasing awareness of opportunities for health and well-being with strengthened hope. The year following PR was dominated by their ongoing challenge to acknowledge limitations and explore opportunities in everyday life. Continuation of healthy transitions was facilitated by peer and professional support. The study highlights the personal resources that patients with COPD have access to in order to promote their own health. The study also highlights their vulnerability during illness and rehabilitation. The findings critique time-limited PR and support the current trends towards patient-centred rehabilitation efforts that incorporate user involvement and self-management education.

Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities

PURPOSE OF REVIEW

Experts in palliative care have increasingly recognized the global epidemic of chronic obstructive pulmonary disease (COPD), its astonishing rise in prevalence, and its profound impact on patients' quality of life and functional capacity. Unfortunately, patients with COPD receive less advance care planning (ACP) and palliative care as compared with patients with other diseases with similar prognoses. This review highlights recent advances in identifying barriers to ACP and opportunities for providing more effective and timely palliative care.

RECENT FINDINGS

Patients with COPD identify dyspnea as their most disabling symptom. Disease-directed care provides only partial relief from dyspnea, which eventually becomes refractory and requires transition to palliative care. Throughout all stages of COPD, however, integrating palliative care with disease-directed treatments improves patients' well being and functional capacities. Observational studies have identified multiple barriers to effective ACP. Because of the unique disease trajectory of COPD, professional groups have proposed new models for palliative care specifically tailored to COPD.

SUMMARY

Patients with COPD benefit from better integration of palliative and disease-specific care throughout the course of their disease from diagnosis to death. Pulmonary rehabilitation may provide a platform for coordinating integrated care. Health agencies will increasingly expect better coordination of services for patients with this progressive, disabling, and eventually terminal disease.