Rocker Graeme M, Cook Deborah
Dalhousie University, QEII Health Sciences Centre Head, Division of Respirology #4457 Halifax Inrmary 1796 Summer Street, Halifax, NS, B3H 3A7.
Clin Invest Med. 2013 Jun 1;36(3):E114-20. doi: 10.25011/cim.v36i3.19721.
Chronic Obstructive Pulmonary Disease (COPD) is the most common cause of admission to acute care facilities in Canada. The burden of illness for patients, caregivers and the health care system is profound. Dyspnea in advanced COPD pervades all aspects of patients' lives. When increasing symptom burden limits patients to their homes, crucial primary care services become less accessible, and care of end-stage COPD becomes increasingly fragmented and reactive. Given the considerable physical and psychosocial consequences of advanced COPD, this phase can be devastating for patients and families. In this article we outline the need for clinical interventions and re-organized models of care designed for better continuity to achieve more favorable outcomes for these patients and their families. Outreach programs and use of personalized action plans that include advice on careful use of opioids can be remarkably effective. The move toward an integrated approach to COPD management with more effective advance care planning will help patients and their families make informed decisions throughout the illness trajectory. Intensive medical treatment focused on increasing survival can coexist with both holistic and palliative approaches to improve the quality of life of patients with severe end-stage COPD.
慢性阻塞性肺疾病（COPD）是加拿大急性护理机构收治患者的最常见原因。其给患者、护理人员及医疗保健系统带来的疾病负担极为沉重。晚期COPD患者的呼吸困难贯穿其生活的方方面面。当症状负担不断加重致使患者只能居家时，关键的初级保健服务就变得难以获得，晚期COPD的护理也日益变得零散且被动。鉴于晚期COPD会造成相当严重的身体和心理社会后果，这一阶段对患者及其家庭而言可能是灾难性的。在本文中，我们概述了临床干预的必要性以及为实现更好的连续性而重新组织的护理模式，以便为这些患者及其家庭取得更有利的结果。外展项目以及使用包含谨慎使用阿片类药物建议的个性化行动计划可能会非常有效。采用综合方法管理COPD并进行更有效的预先护理规划，将有助于患者及其家庭在整个疾病进程中做出明智的决策。专注于提高生存率的强化医疗治疗可以与整体和姑息治疗方法并存，以改善重度晚期COPD患者的生活质量。
