End-of-life care for patients with respiratory disease

Overview

Palliative and end-of-life care in advanced respiratory disease (COPD, ILD, lung cancer) focuses on symptom control - particularly breathlessness - alongside the same principles of advance care planning as other terminal illness
Breathlessness at the end of life is often undertreated compared with pain, partly from clinician reluctance around opioid use for dyspnoea

Refractory breathlessness in end-stage lung disease often persists despite optimised disease-directed therapy - the target shifts from correcting the underlying physiology to reducing the perception of breathlessness

Identifying the shift from disease-modifying to palliative-predominant care requires recognising disease trajectory - COPD often has a fluctuating, harder-to-predict trajectory than cancer, making timely palliative conversations easy to delay

Low-dose opioids are effective and safe for refractory breathlessness at end of life when appropriately titrated - not simply "hastening death," a common misconception that under-treats symptoms
Benzodiazepines as an adjunct for breathlessness-associated anxiety, not first-line alone
A handheld fan directed at the face - a simple, evidence-supported non-pharmacological measure for breathlessness
Advance care planning (ceiling of treatment, preferred place of death, resuscitation status) should occur proactively, not only when death is imminent, given COPD's unpredictable trajectory

Early integration of palliative care alongside disease-directed treatment (not sequential, delayed referral) improves symptom control and, in some cancer populations, survival

5 more sections, plus exam facts

Premium unlocks every note across every specialty, and the full exam fact library behind it.