End stage pulmonary disease

Abstract

Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality. Lung cancer is the number one cause of cancer mortality by far. End-stage lung disease and lung cancer will often result in distressing symptoms such as dyspnea and pain. The impact of advanced nonmalignant lung disease such as COPD on quality of life and functioning is similar to that of lung cancer. Palliative care should be offered to those patients early and concurrently with restorative care. Early palliative care in lung cancer improves quality of life and can even prolong life. A timely discussion about end-of-life care including mechanical ventilation should be encouraged in advanced cases. The fear of causing emotional distress is usually unfounded and the patients will appreciate the honest discussion. Palliative care in lung disease as in general should follow a multidisciplinary approach with a special emphasis on dyspnea and pain control. Pulmonary rehabilitation remains a useful tool in palliative care. Terminal discontinuation of mechanical ventilation is ethically justified if the patient or his surrogate decision maker wants that. Immediate extubation and gradual decrease of ventilatory support are both acceptable and each has advantages and disadvantages. Aggressive use of opiates and sedatives in a dying person is acceptable even if the risk of hastening death is high.