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Chronic obstructive pulmonary disease - Management
What drug treatments (including oxygen) can I use in people with end-stage COPD?
- Offer an opioid as first-line treatment to palliate breathlessness in people with end-stage chronic obstructive pulmonary disease (COPD) that is unresponsive to other medical treatment.
- There is wide variation in the regimens used in trials and recommended in the literature. Seek specialist advice, or follow recommendations in the section on Opioids in the CKS topic on Palliative cancer care - dyspnoea.
- If an opioid (in addition to other medical treatment) is insufficient to palliate breathlessness, offer a trial of either or both of the following:
- Benzodiazepines (particularly if there is a significant anxiety component).
- Oxygen (if the person is not already on long-term oxygen).
- Short-burst oxygen therapy (intermittent use of supplemental oxygen for periods of 10–20 minutes) may be helpful.
- Use a 24% or 28% Venturi mask at a flow rate of 2–4 L/min.
- Seek specialist advice if these measures fail to palliative breathlessness sufficiently, or if considering a trial of tricyclic antidepressants or antipsychotics.
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