End stage chronic obstructive pulmonary disease

Nicolino Ambrosino, Marco Gherardi, Nicoletta Carpenè


Many patients with chronic obstructive pulmonary disease (COPD) die each year as those with lung cancer but current
guidelines make few recommendations on the care for the most severe patients i.e. those with Global Initiative for Chronic
Obstructive Lung Disease (GOLD) stages III and IV with chronic respiratory failure.

Only smoking cessation and long term oxygen therapy (LTOT) improve survival in COPD. Although non invasive positive
pressure ventilation (NPPV) may have an adjunctive role in the management of chronic respiratory insufficiency there is little
evidence for its use in the routine management of stable hypercapnic COPD patients. At difference, several prospective,
randomised, controlled studies, systematic reviews and meta-analyses show good level of evidence for clinical efficacy of
NPPV in the treatment of acute on chronic respiratory failure due to acute exacerbations of COPD. NPPV is also alternative to
invasive ventilation for symptom relief in end stage COPD.

Surgical interventions for end stage COPD like bullectomy, different modalities of lung volume reduction surgery and lung
transplantation are likely to be of value to only a small percentage of patients. Nevertheless, there are specific indications,
which, when added to pulmonary rehabilitation will further advance exercise capacity and quality of life.
As in other chronic diseases when severity of disease increases along the natural history, therapy aimed to prolong life
becomes less and less important in comparison to palliative therapy aimed to relieve symptoms. The most effective
treatments for dyspnoea are bronchodilators, although also opiates may improve dyspnoea. Supplemental oxygen reduce
exertional breathlessness and improve exercise tolerance in hypoxaemic COPD patients. There are difficulties in treating
with antidepressant the frail and elderly COPD patients.

Good clinical care can prevent or alleviate suffering by assessing symptoms and providing psychological and social support
to the patients and their families.
Czasopismo Pneumonologia i Alergologia Polska dostęne jest również w Ikamed - księgarnia medyczna

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tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail: viamedica@viamedica.pl