WHAT THIS REPORT ADDS:

• There is a clear need to address end-of-life issues in patients with severe COPD.

ORLANDO, FLA—Severe COPD has a five-year mortality of about 50%. For COPD patients who require mechanical ventilation, one-year mortality is 60%. Despite these grim statistics, little has been done to address patients’ end-of-life needs. At the annual meeting of the American College of Chest Physicians, Michel Chalhoub, MD, from Staten Island University Hospital in New York, discussed the results of a study that he and his colleagues conducted to determine the need for end-of-life care counseling in patients with moderate to severe COPD.[1]

After patients with severe COPD were identified based on an FEV1 below 50% of that predicted, they were asked the following questions:
• Did they know their diagnosis and its seriousness?
• Had their physicians discussed end-of-life care with them?
• Did they want to discuss end-of-life care with their physicians?
• Would they be willing to undergo mechanical ventilation again if they had already done so once?

Eighty-three patients were interviewed. Twenty-six percent of them did not know their diagnosis, and of those who did, 55% did not know how serious it was. Eighty-three percent of the patients had never had a discussion regarding end-of-life care with their physicians, yet 80% of all patients wanted such a discussion. Of the patients who had received mechanical ventilation before, 50% said they never wanted to undergo it again.

NO ONE IS TALKING

“These are patients who have worse mortality than [do those with] stage I lung cancer,” stressed Dr. Chalhoub. “Patients had, on average, three outpatient visits to their primary care physician or pulmonologist in the previous six months.” Even so, he continued, no one had tried to talk with them about end-of-life care.

Physicians were not approaching their patients regarding this issue, nor were patients approaching their physicians. “That’s part of the problem,” said Dr. Chalhoub. Often, he noted, patients are relieved to learn that they have chronic lung disease such as bronchitis or emphysema, rather than cancer, because they assume that their prognosis is better. In diseases such as AIDS and lung cancer, physicians are much more aggressive in counseling their patients. “I think that the problem is coming from two sides—the patient and the physician,” observed Dr. Chalhoub. “We strongly recommend that advance directives and end-of-life care be an integral part of the comprehensive management of patients with COPD.”

—Gale Jurasek

Reference
1. Chalhoub M. Ethics in moderate to severe chronic obstructive pulmonary disease. Presented at: annual meeting of the American College of Chest Physicians; October 27, 2003; Orlando, Fla.

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