Vermylen Julia H, Szmuilowicz Eytan, Kalhan Ravi
Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Section of Palliative Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Int J Chron Obstruct Pulmon Dis. 2015 Aug 6;10:1543-51. doi: 10.2147/COPD.S74641. eCollection 2015.
COPD is a leading cause of morbidity and mortality worldwide. Patients suffer from refractory breathlessness, unrecognized anxiety and depression, and decreased quality of life. Palliative care improves symptom management, patient reported health-related quality of life, cost savings, and mortality though the majority of patients with COPD die without access to palliative care. There are many barriers to providing palliative care to patients with COPD including the difficulty in prognosticating a patient's course causing referrals to occur late in a patient's disease. Additionally, physicians avoid conversations about advance care planning due to unique communication barriers present with patients with COPD. Lastly, many health systems are not set up to provide trained palliative care physicians to patients with chronic disease including COPD. This review analyzes the above challenges, the available data regarding palliative care applied to the COPD population, and proposes an alternative approach to address the unmet needs of patients with COPD with proactive primary palliative care.
慢性阻塞性肺疾病（COPD）是全球发病和死亡的主要原因。患者会出现难治性呼吸困难、未被识别的焦虑和抑郁，以及生活质量下降。姑息治疗可改善症状管理、患者报告的与健康相关的生活质量、节省成本并降低死亡率，尽管大多数慢性阻塞性肺疾病患者在未获得姑息治疗的情况下死亡。为慢性阻塞性肺疾病患者提供姑息治疗存在许多障碍，包括难以预测患者的病程，导致在患者疾病晚期才进行转诊。此外，由于慢性阻塞性肺疾病患者存在独特的沟通障碍，医生避免进行关于预先护理计划的谈话。最后，许多卫生系统并未设立为包括慢性阻塞性肺疾病患者在内的慢性病患者提供经过培训的姑息治疗医生。本综述分析了上述挑战、应用于慢性阻塞性肺疾病人群的姑息治疗的现有数据，并提出了一种替代方法，通过积极的初级姑息治疗来满足慢性阻塞性肺疾病患者未得到满足的需求。
