Chronic obstructive pulmonary disease (COPD) patients can benefit from more palliative care referrals.
This is according to Dr. Anand Iyer, a pulmonary critical care physician scientist and associate professor in the Division of Pulmonary, Allergy, and Critical Care Medicine; the Division of Gerontology, Geriatrics, and Palliative Care; and the School of Nursing at the University of Alabama at Birmingham (UAB).
In a recent Medscape podcast, Iyer presented a case study involving a 78-year-old male patient with end-stage COPD. The patient experienced four hospitalizations in the prior year, including two intensive care unit stays.
“Thinking of things holistically and comprehensively could have made a huge difference. I think with his trajectory and overall well-being, a lot of people will put him into this bucket of end-stage COPD,” Iyer said during the podcast. “They would say, ‘Oh, there’s not much I can do.’ Thinking of things with a palliative approach gives me the ability to say, ‘What else can we do?’ There are so many things.”
Palliative care can help address severe symptoms that COPD patients often experience, including breathlessness, coughing and psychosocial concerns such as anxiety and depression. These services can also improve symptoms associated with comorbidities that patient may have, be it heart disease or pulmonary hypertension, among others.
Breathlessness is one of COPD’s most distressing symptoms, according to Iyer. Patients often describe it as a horrific experience that can feel like drowning, he said. A palliative care team can introduce interventions such as low-dose opioids to help reduce breathlessness and pain. They can also assist with goals-of-care conversations and advance care planning, as well as family caregiver support, Iyer indicated.
“I would go ahead and get palliative care on board as a team, as a specialty referral or secondary palliative care … With this approach, there’s a team that can help me with symptom management,” Iyer said. “Because their anxiety is quite high. Their symptom burden is quite high. And because of the way I’ve engaged that team early, all of us are happier. The patient’s happier.”
