Dean Mervyn M
Palliative Care Department, Western Memorial Regional Hospital, Western Health Authority, Newfoundland & Labrador, Canada.
Prim Care Respir J. 2008 Mar;17(1):46-50. doi: 10.3132/pcrj.2008.00007.
Patients with chronic obstructive pulmonary disease (COPD) receive poor end-of-life (EoL) care, in part because their disease course is not predictable. If the family physician would not be surprised at the patient's death within a year, then EoL issues should be raised for discussion. Embarking on such a discussion has the potential to enhance the patient's quality of life and EoL care, thereby avoiding unnecessary treatments or interventions. An Advance Health Care Directive can be useful. Appropriately-used systemic (not nebulised) opioids are safe and effective for managing dyspnoea. The family physician is in an excellent position to provide comprehensive EoL care for COPD patients.
慢性阻塞性肺疾病（COPD）患者在生命末期（EoL）接受的护理质量较差，部分原因是其病程不可预测。如果家庭医生对于患者在一年内死亡并不感到意外，那么就应该提出生命末期问题进行讨论。开展这样的讨论有可能提高患者的生活质量和生命末期护理水平，从而避免不必要的治疗或干预。预先医疗指示可能会有所帮助。合理使用的全身性（而非雾化）阿片类药物对于治疗呼吸困难是安全有效的。家庭医生处于为COPD患者提供全面生命末期护理的有利位置。
