Are COPD patients referred to palliative care?

Introduction: The consultation on a strategy for COPD in England suggests patients with COPD should be considered for end of life care particularly if they have the following markers of severity: 1. Severe airflow obstruction (FEV1<30%) 2. Low BMI (<20) 3. Housebound 4. Two or more admissions in previous year 5. Respiratory failure or previous ventilation. Method: A list of patients discharged in Jan 2007 with a diagnosis of COPD was obtained. Of 69 patients identified 40 were chosen at random and included. The case notes were investigated and the markers of severity met were recorded. It was also determined if the patients had survived to discharge, 3 months and 3 years. Results: No. of markers of severity met Patients Died during admission Survived to discharge Alive at 3 months Alive at 3 years 0 8 2 (25%) 6 (75%) 5 (63%) 4 (50%) 1 12 1 (8%) 11 (92%) 10 (83%) 6 (50%) 2 10 4 (40%) 6 (60%) 5 (50%) 3 (30%) 3 9 5 (55%) 4 (44%) 2 (22%) 1 (11%) 4 1 1 (100%) 5 0 Discussion: None of the patients had all 5 criteria measured during, or prior to the admission in question illustrating the importance of thoroughly assessing level of disability in COPD. When considering the patients alive at 3 years there was a trend towards fewer patients surviving the greater the number of severity criteria they met. However the patient who met 4 of the severity criteria, and survived to 3 years demonstrates the difficulty in precisely predicting the transition to the end of life in COPD and thus timing of involvement of palliative care. Only 3 of the 40 patients were considered for specialist palliative care, and this consisted of using the Liverpool care pathway in the hours prior to death. More studies are needed to look into optimal timing for end of life care in COPD.