Abstract
Exacerbations of chronic obstructive pulmonary disease (COPD) may lead to a rapid decline in health and subsequent death, an unfortunate tyranny of having COPD—an irreversible health condition of 16 million individuals in the USA totaling 60 million in the world. While COPD is the third largest leading cause of death, causing 3.23 million deaths worldwide in 2019 (according to the WHO), most patients with COPD do not receive adequate treatment at the end stages of life. Although death is inevitable, the trajectory towards end-of-life is less predictable in severe COPD. Thus, clinician-patient discussion for end-of-life and palliative care could bring a meaningful life-prospective to patients with advanced COPD. Here, we summarized the current understanding and treatment of COPD. This review also highlights the importance of patient-centered discussion and summarizes current status of managing patients with advanced COPD.
Highlights
Chronic obstructive pulmonary disease (COPD) affects more than 10 million people in the United States [1,2]
The purpose of this review is to summarize pathophysiology, pathogen-induced disease exacerbation, pharmacological management, and recent research regarding end-of-life care for patients with advanced COPD
The Global Initiative for Chronic Obstructive Lung Disease (GOLD) is the standard reference for stage determination based on spirometry results
Summary
Chronic obstructive pulmonary disease (COPD) affects more than 10 million people in the United States [1,2]. The presence of comorbidities impacts COPD patients negatively, increasing the likelihood of hospitalization and mortality and reducing the quality of life [4,5,6]. The current general clinical management of COPD is aimed at treating and preventing acute exacerbation, focusing on the underlying pathophysiology, e.g., treating bronchoconstriction, reducing hyperinflation, and airway inflammation [7]. The total traditional therapy for advanced COPD produces a modest relief of symptoms, leaving these patients vulnerable and substantially reducing the health-related quality of life [9,10,11]. The purpose of this review is to summarize pathophysiology, pathogen-induced disease exacerbation, pharmacological management, and recent research regarding end-of-life care for patients with advanced COPD
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