Department of General Practice and Primary Care, King's College London, UK.
Br J Gen Pract. 2011 Jun;61(587):e362-70. doi: 10.3399/bjgp11X578043.
Calls for better end-of-life care for advanced chronic obstructive pulmonary disease (COPD) reflect the large number who die from the disease and their considerable unmet needs.
To determine palliative care needs in advanced COPD.
Cross-sectional interview study in patients' homes using structured questionnaires generated from 44 south London general practices.
One hundred and sixty-three (61% response) patients were interviewed, mean age 72 years, 50% female, with diagnosis of COPD and at least two of: forced expiratory volume in the first second (FEV(1)) <40% predicted, hospital admissions or acute severe exacerbations with COPD, long-term oxygen therapy, cor pulmonale, use of oral steroids, and being housebound. Patients with advanced cancer, severe alcohol-related or mental health problems, or learning difficulties, were excluded; 145 patients were included in the analysis.
One hundred and twenty-eight (88%) participants reported shortness of breath most days/every day, 45% were housebound, 75% had a carer. Medical records indicated that participants were at least as severe as non-participants. Eighty-two (57%) had severe breathlessness; 134 (92%) said breathlessness was their most important problem; 31 (21%) were on suboptimal treatment; 42 (30%) who were severely affected had not been admitted to hospital in the previous 2 years; 86 of 102 who had been admitted would want admission again if unwell to the same extent. None expressed existential concerns and few discussed need in terms of end-of-life care, despite severe breathlessness and impairment.
Needs in advanced COPD were considerable, with many reporting severe intractable breathlessness. Palliation of breathlessness was a priority, but discussion of need was seldom in terms of 'end-of-life care'.
对晚期慢性阻塞性肺疾病（COPD）的临终关怀的呼吁反映了大量死于该疾病且存在大量未满足需求的患者。
确定晚期 COPD 的姑息治疗需求。
在患者家中进行横断面访谈研究，使用来自 44 家伦敦南部普通诊所的结构化问卷。
对 163 名（61%的应答率）患者进行了访谈，平均年龄为 72 岁，50%为女性，诊断为 COPD，并且至少有以下两种情况：第一秒用力呼气量（FEV1）<40%预计值、住院或 COPD 急性加重、长期氧疗、肺心病、口服类固醇使用和长期居家。排除患有晚期癌症、严重酒精相关或精神健康问题或学习困难的患者；145 名患者纳入分析。
128 名（88%）参与者报告每天大部分时间/每天都有呼吸困难，45%的患者居家，75%的患者有照顾者。病历表明，参与者的病情至少与未参与者一样严重。82 名（57%）患者有严重的呼吸困难；134 名（92%）患者表示呼吸困难是他们最重要的问题；31 名（21%）患者接受的治疗不理想；42 名（30%）严重受影响的患者在过去 2 年内未住院治疗；86 名曾住院的患者中有 102 名如果病情相同，会再次入院。尽管呼吸困难严重且身体受损，但没有患者表达存在问题的担忧，也很少有人从临终关怀的角度讨论需求。
晚期 COPD 的需求相当大，许多患者报告严重的难治性呼吸困难。缓解呼吸困难是当务之急，但对需求的讨论很少涉及“临终关怀”。
