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Advance care planning in chronic obstructive pulmonary disease: barriers and opportunities

Heffner, John E

Current Opinion in Pulmonary Medicine: March 2011 - Volume 17 - Issue 2 - p 103–109
doi: 10.1097/MCP.0b013e328341ce80
Obstructive, occupational and environmental diseases: Edited by Basil Varkey

Purpose of review Experts in palliative care have increasingly recognized the global epidemic of chronic obstructive pulmonary disease (COPD), its astonishing rise in prevalence, and its profound impact on patients' quality of life and functional capacity. Unfortunately, patients with COPD receive less advance care planning (ACP) and palliative care as compared with patients with other diseases with similar prognoses. This review highlights recent advances in identifying barriers to ACP and opportunities for providing more effective and timely palliative care.

Recent findings Patients with COPD identify dyspnea as their most disabling symptom. Disease-directed care provides only partial relief from dyspnea, which eventually becomes refractory and requires transition to palliative care. Throughout all stages of COPD, however, integrating palliative care with disease-directed treatments improves patients' well being and functional capacities. Observational studies have identified multiple barriers to effective ACP. Because of the unique disease trajectory of COPD, professional groups have proposed new models for palliative care specifically tailored to COPD.

Summary Patients with COPD benefit from better integration of palliative and disease-specific care throughout the course of their disease from diagnosis to death. Pulmonary rehabilitation may provide a platform for coordinating integrated care. Health agencies will increasingly expect better coordination of services for patients with this progressive, disabling, and eventually terminal disease.

Providence Portland Medical Center, Oregon Health and Science Center, Portland, Oregon, USA

Correspondence to John E. Heffner, MD, Providence Portland Medical Center, 5050 NE Hoyt St, Suite 540, Portland, OR 97213, USA Tel: +1 503 215 6258; e-mail:

© 2011 Lippincott Williams & Wilkins, Inc.