Mitigating the impact of breathlessness in Chronic Obstructive Pulmonary Disease: can a structured specialty palliative care intervention fill in the gap in our treatment algorithms?
Main Article Content
Abstract
Breathlessness is a distressing symptom, uniformly faced at some point in the disease process in all patients with Chronic Obstructive Pulmonary Disease (COPD). Despite maximal medical therapy and pulmonary rehabilitation, patients with COPD continue to experience refractory dyspnea, pain, poor appetite, limitations of physical activity, emotional distress, depression and overall poor health-related quality of life. Our current GOLD ABE pharmacologic treatment algorithm provides maximal disease specific therapy directed at optimization of physiologic airflow obstruction and exacerbation frequency, however leaving a gap in how best to approach the complex and multifactorial symptom of refractory breathlessness that occurs despite these pharmacologic interventions and pulmonary rehabilitation. The comprehensive and multidisciplinary approach of specialty palliative care may well fill this gap in our treatment algorithms. In this review, we will review the growing body of literature on the definitions and role of primary and specialty palliative care in the treatment of patients with COPD, review the components of a structured palliative care intervention in advanced lung disease, review the current pharmacologic and non-pharmacologic treatments for breathlessness, the identified barriers to palliative care intervention and consider the future direction of palliative care engagement in patients with COPD.
Keywords:
Chronic Obstructive Pulmonary Disease, structured specialty palliative care intervention, treatment algorithms, breathlessness, COPD
Article Details
How to Cite
SWAMI, Mehak; PROVOST, Karin.
Mitigating the impact of breathlessness in Chronic Obstructive Pulmonary Disease: can a structured specialty palliative care intervention fill in the gap in our treatment algorithms?.
Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/3498>. Date accessed: 16 apr. 2024.
doi: https://doi.org/10.18103/mra.v11i2.3498.
Section
Review Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
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2. Vogelmeier C, Agusti A, Anzueto A, et al. Global Initiative for Chronic Lung Disease: Global Strategy for the Diagnosis, Mangaement and Prevention of Chronic Obstructive Lung Disease 2023. 2022.
3. Elkington H, White P, Addington-Hall J, Higgs R, Pettinari C. The last year of life of COPD: a qualitative study of symptoms and services. Respiratory medicine. 2004;98(5): 439-445.
4. Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000;55(12):1000-1006.
5. Panagioti M, Scott C, Blakemore A, Coventry PA. Overview of the prevalence, impact, and management of depression and anxiety in chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2014;9:1289-1306.
6. Light RW, Merrill EJ, Despars JA, Gordon GH, Mutalipassi LR. Prevalence of depression and anxiety in patients with COPD. Relationship to functional capacity. Chest. 1985;87(1):35-38.
7. Schroedl CJ, Yount SE, Szmuilowicz E, Hutchison PJ, Rosenberg SR, Kalhan R. A qualitative study of unmet healthcare needs in chronic obstructive pulmonary disease. A potential role for specialist palliative care? Ann Am Thorac Soc. 2014;11(9):1433-1438.
8. HajGhanbari B, Garland SJ, Road JD, Reid WD. Pain and physical performance in people with COPD. Respiratory medicine. 2013; 107(11):1692-1699.
9. Altenburg WA, Bossenbroek L, de Greef MH, Kerstjens HA, ten Hacken NH, Wempe JB. Functional and psychological variables both affect daily physical activity in COPD: a structural equations model. Respiratory medicine. 2013;107(11):1740-1747.
10. Wysham NG, Cox CE, Wolf SP, Kamal AH. The Symptom Burden of Chronic Lung Disease Compared to Lung Cancer at the Time of Referral for Palliative Care Consultation. Ann Am Thorac Soc. 2015.
11. Habraken JM, ter Riet G, Gore JM, et al. Health-related quality of life in end-stage COPD and lung cancer patients. Journal of pain and symptom management. 2009; 37 (6):973-981.
12. Faes K, De Frene V, Cohen J, Annemans L. Resource Use and Health Care Costs of COPD Patients at the End of Life: A Systematic Review. Journal of pain and symptom management. 2016;52(4):588-599.
13. Au DH, Udris EM, Fihn SD, McDonell MB, Curtis J. Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Archives of Internal Medicine. 2006;166(3):326-331.
14. Rush B, Hertz P, Bond A, McDermid RC, Celi LA. Use of Palliative Care in Patients With End-Stage COPD and Receiving Home Oxygen: National Trends and Barriers to Care in the United States. Chest. 2017;151(1):41-46.
15. Brown CE, Engelberg RA, Nielsen EL, Curtis JR. Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer. Ann Am Thorac Soc. 2016;13(5):684-689.
16. Goodridge D, Lawson J, Duggleby W, Marciniuk D, Rennie D, Stang M. Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life. Respiratory medicine. 2008;102(6):885-891.
17. Beernaert K, Cohen J, Deliens L, et al. Referral to palliative care in COPD and other chronic diseases: a population-based study. Respiratory medicine. 2013;107(11):1731-1739.
18. Singer AE, Goebel JR, Kim YS, et al. Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review. J Palliat Med. 2016;19(9):995-1008.
19. Kraskovsky V, Schneider J, Mador MJ, Provost KA. Longer Duration of Palliative Care in Patients With COPD Is Associated With Death Outside the Hospital. J Palliat Care. 2022;37(2):125-133.
20. Iyer AS, Benzo RP, Bakitas MA. Easing the Tension Between Palliative Care and Intensive Care in Chronic Obstructive Pulmonary Disease. J Palliat Care. 2018;33(3):123-124.
21. Maddocks M, Lovell N, Booth S, Man WD, Higginson IJ. Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease. Lancet (London, England). 2017; 390(10098):988-1002.
22. Heffner JE. Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities. Curr Opin Pulm Med. 2011;17(2):103-109.
23. Argyropoulou P, Patakas D, Koukou A, Vasiliadis P, Georgopoulos D. Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease. Respiration. 1993;60(4):216-220.
24. Borson S, McDonald GJ, Gayle T, Deffebach M, Lakshminarayan S, VanTuinen C. Improvement in mood, physical symptoms, and function with nortriptyline for depression in patients with chronic obstructive pulmonary disease. Psychosomatics. 1992;33(2):190-201.
25. O M, S R, N T, A H. Effect of treatment of depression and anxiety on physiological state of severe COPD patients. Egyptian Journal of Chest Diseases and Tuberculosis. 2015;64:29-34.
26. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742.
27. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. Jama. 2009;302(7):741-749.
28. Bakitas MA, Tosteson TD, Li Z, et al. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2015;33(13):1438-1445.
29. Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med. 2011;14(1):17-23.
30. Murray SA, Boyd K, Sheikh A, Thomas K, Higginson IJ. Developing primary palliative care. BMJ (Clinical research ed). 2004;329(7474):1056-1057.
31. Sullivan DR, Iyer AS, Enguidanos S, et al. Palliative Care Early in the Care Continuum among Patients with Serious Respiratory Illness: An Official ATS/AAHPM/HPNA/ SWHPN Policy Statement. Am J Respir Crit Care Med. 2022;206(6):e44-e69.
32. Iyer AS, Sullivan DR, Lindell KO, Reinke LF. The Role of Palliative Care in COPD. Chest. 2022;161(5):1250-1262.
33. American Academy of H, Palliative M, Center to Advance Palliative C, et al. National Consensus Project for Quality Palliative Care: Clinical Practice Guidelines for quality palliative care, executive summary. J Palliat Med. 2004;7(5):611-627.
34. Selecky PA, Eliasson CA, Hall RI, et al. Palliative and end-of-life care for patients with cardiopulmonary diseases: American College of Chest Physicians position statement. Chest. 2005;128(5):3599-3610.
35. Lanken PN, Terry PB, Delisser HM, et al. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med. 2008;177(8):912-927.
36. Ekstrom M, Nilsson F, Abernethy AA, Currow DC. Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review. Ann Am Thorac Soc. 2015; 12(7):1079-1092.
37. Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ (Clinical research ed). 2003;327(7414):523-528.
38. Light RW, Stansbury DW, Webster JS. Effect of 30 mg of morphine alone or with promethazine or prochlorperazine on the exercise capacity of patients with COPD. Chest. 1996;109(4):975-981.
39. Eiser N, Denman WT, West C, Luce P. Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the "pink puffer" syndrome. The European respiratory journal. 1991;4(8):926-931.
40. Woodcock AA, Gross ER, Gellert A, Shah S, Johnson M, Geddes DM. Effects of dihydrocodeine, alcohol, and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases. N Engl J Med. 1981; 305(27):1611-1616.
41. Abdallah SJ, Wilkinson-Maitland C, Saad N, et al. Effect of morphine on breathlessness and exercise endurance in advanced COPD: a randomised crossover trial. The European respiratory journal. 2017;50(4).
42. Light RW, Muro JR, Sato RI, Stansbury DW, Fischer CE, Brown SE. Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1989;139(1):126-133.
43. Clemens KE, Klaschik E. Effect of hydromorphone on ventilation in palliative care patients with dyspnea. Support Care Cancer. 2008;16(1):93-99.
44. Clemens KE, Klaschik E. Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. Journal of pain and symptom management. 2007;33(4):473-481.
45. Verberkt CA, van den Beuken-van Everdingen MHJ, Schols J, Hameleers N, Wouters EFM, Janssen DJA. Effect of Sustained-Release Morphine for Refractory Breathlessness in Chronic Obstructive Pulmonary Disease on Health Status: A Randomized Clinical Trial. JAMA Intern Med. 2020;180(10):1306-1314.
46. Currow D, Louw S, McCloud P, et al. Regular, sustained-release morphine for chronic breathlessness: a multicentre, double-blind, randomised, placebo-controlled trial. Thorax. 2020;75(1):50-56.
47. Ekstrom M, Ferreira D, Chang S, et al. Effect of Regular, Low-Dose, Extended-release Morphine on Chronic Breathlessness in Chronic Obstructive Pulmonary Disease: The BEAMS Randomized Clinical Trial. Jama. 2022;328(20):2022-2032.
48. Poole PJ, Veale AG, Black PN. The effect of sustained-release morphine on breathlessness and quality of life in severe chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(6 Pt 1):1877-1880.
49. Simon ST, Higginson IJ, Booth S, Harding R, Weingartner V, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2016;10(10):CD007354.
50. Eimer M, Cable T, Gal P, Rothenberger LA, McCue JD. Effects of clorazepate on breathlessness and exercise tolerance in patients with chronic airflow obstruction. J Fam Pract. 1985;21(5):359-362.
51. Man GC, Hsu K, Sproule BJ. Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest. 1986;90(6):832-836.
52. Navigante AH, Cerchietti LC, Castro MA, Lutteral MA, Cabalar ME. Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. Journal of pain and symptom management. 2006;31(1):38-47.
53. Navigante AH, Castro MA, Cerchietti LC. Morphine versus midazolam as upfront therapy to control dyspnea perception in cancer patients while its underlying cause is sought or treated. Journal of pain and symptom management. 2010;39(5):820-830.
54. Stege G, Heijdra YF, van den Elshout FJ, et al. Temazepam 10mg does not affect breathing and gas exchange in patients with severe normocapnic COPD. Respiratory medicine. 2010;104(4):518-524.
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