Ansari Aziz A, Pomerantz Daniel H, Jayes Robert L, Aguirre Eric A, Havyer Rachel D
1 Division of Hospital Medicine, Loyola University Medical Center, Maywood, IL, USA.
2 Division of General Internal Medicine and Department of Family Medicine (Palliative Care), Albert Einstein College of Medicine Bronx, New York, NY, USA.
J Palliat Care. 2019 Apr;34(2):85-91. doi: 10.1177/0825859718819437. Epub 2018 Dec 26.
Chronic obstructive pulmonary disease (COPD) poses challenges not only in symptom management but also in prognostication. Managing COPD requires clinicians to be proficient in the primary palliative care skills of symptom management and communication focused on eliciting goals and preferences. Dyspnea should initially be managed with the combination of long-acting muscarinic antagonists and long-acting β-agonist inhalers, adding inhaled corticosteroids if symptoms persist. Opioids for the relief of dyspnea are safe when used at appropriate doses. Oxygen is only effective for relieving dyspnea in patients with severe hypoxemia. The relapsing-remitting nature of COPD makes prognostication challenging; however, there are tools to guide clinicians and patients in making plans both with respect to prognosis and symptom burden. Preparedness planning techniques promote detailed culturally appropriate conversations which allow patients and clinicians to consider disease-specific complications and develop goal-concordant treatment plans.
慢性阻塞性肺疾病（COPD）不仅在症状管理方面带来挑战，在预后判断方面也存在困难。管理COPD要求临床医生熟练掌握症状管理以及侧重于引出目标和偏好的沟通等初级姑息治疗技能。呼吸困难最初应采用长效毒蕈碱拮抗剂和长效β受体激动剂吸入剂联合治疗，若症状持续则加用吸入性糖皮质激素。以适当剂量使用阿片类药物缓解呼吸困难是安全的。氧气仅对严重低氧血症患者缓解呼吸困难有效。COPD的复发-缓解特性使得预后判断具有挑战性；然而，有一些工具可指导临床医生和患者制定关于预后和症状负担的计划。备灾规划技术促进进行详细的、符合文化背景的对话，使患者和临床医生能够考虑特定疾病的并发症并制定目标一致的治疗计划。
