Harrington Sarah E, Rogers Elizabeth, Davis Megan
University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
Curr Opin Pulm Med. 2017 Mar;23(2):154-160. doi: 10.1097/MCP.0000000000000358.
Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality worldwide and is expected to increase as the population ages. Patients have a high symptom burden, low healthcare quality of life, and unmet needs at the end of life. This review highlights specific palliative care needs of patients with advanced COPD and opportunities to integrate palliative care into standard practice.
There are many barriers to providing integrated palliative care in COPD, including difficulty with prognostication, communication barriers surrounding advance care planning, and lack of access to specialty palliative care. Because of the unique disease trajectory, emphases on early and primary palliative care are being studied in this patient population.
Palliative care is appropriate for patients with COPD and should be integrated with disease-specific therapies. The line between life prolonging and palliative care undoubtedly overlaps and maximizing quality of life throughout the continuum of care should be prioritized for patients with this progressive illness.
慢性阻塞性肺疾病（COPD）是全球发病和死亡的主要原因，且预计随着人口老龄化而增加。患者症状负担重，医疗保健生活质量低，临终需求未得到满足。本综述强调了晚期COPD患者的特定姑息治疗需求以及将姑息治疗纳入标准实践的机会。
在COPD中提供综合姑息治疗存在许多障碍，包括预后判断困难、围绕预先护理计划的沟通障碍以及难以获得专科姑息治疗。由于独特的疾病轨迹，正在该患者群体中研究对早期和初级姑息治疗的重视。
姑息治疗适用于COPD患者，应与针对特定疾病的治疗相结合。延长生命治疗与姑息治疗之间的界限无疑会重叠，对于这种进行性疾病的患者，应优先在整个护理过程中最大化生活质量。
