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Chronic obstructive pulmonary disease - Management
When and how should I discuss end-of-life issues for people with end-stage COPD?

  • Deciding when and how to initiate discussions about end-of-life issues is difficult. Evidence is insufficient to make firm recommendations, but the following may be helpful:
    • Most people with chronic obstructive pulmonary disease (COPD) would find such discussions acceptable; if initiated by the clinician, ideally the discussions should occur when the person is stable rather than deteriorating or being hospitalized.
    • No criteria have been shown to effectively predict survival of 6 months or less. However, several features may indicate the need to discuss end-of-life issues:
      • Forced expiratory volume in 1 second (FEV1) less than 30% predicted.
      • Frequent exacerbations and hospital admissions.
      • Low body mass index or weight loss.
      • Comorbidities (especially left heart failure).
    • Some evidence indicates that people with advanced COPD may wish to discuss:
      • Diagnosis and the disease process (including what COPD is and what causes it) — see Background information.
      • Treatments (including explanations of both long-term treatments, such as inhalers and oxygen, and short-term crisis treatments, such as intubation and mechanical ventilation).
      • Prognosis.
      • What dying might be like and how distressing symptoms might be alleviated.
      • Advance decisions (for example whether or not to treat or hospitalize for an exacerbation, or whether to have life-support measures).
    • Discuss with the person whether to complete a DS1500 form so they can receive a disability living allowance. For more information, see www.dwp.gov.uk.

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