End-Stage COPD: What to Expect at the End of Life

According to the Centers for Disease Control and Prevention, more than 16 million Americans have chronic obstructive pulmonary disease, or COPD. It is a group of conditions that cause breathing difficulties. Tobacco smoke plays a key role in those who have been diagnosed, along with exposure to air pollutants in the home and workplace, genetic factors, and respiratory infections.

While there are many treatments available that can help control symptoms, there is no cure, so it’s still important to know what to expect at the end of life—and what kind of help is available.

End-Stage COPD Symptoms & Complications

COPD’s course is hard to predict because it progresses at different rates. Everyone is different and for this reason it’s important to note that life expectancy is also difficult to determine. Many factors can also play a role, including a person’s smoking history, fitness level, nutrition status, and degree of breathlessness.

However, many people have the following symptoms during end-stage COPD as well as in earlier stages of the illness: coughing, wheezing, large amounts of phlegm/mucus, chest tightness, pain, fatigue, insomnia, and/or constipation.

As a person approaches the end of life, they may experience the following:

• Shortness of breath while resting.
• Trouble with activities of daily living: walking, cooking, dressing, or doing other daily activities.
• Chronic respiratory failure. This is when your respiratory system can no longer expel carbon dioxide from your blood, or when it can no longer take in enough oxygen.
• Respiratory infections, such as flu and pneumonia, can worsen COPD.
• More emergency room visits and overnight hospital stays.
• Anxiety and depression.
• Increased confusion or memory loss. This can be caused by lack of oxygen or too much carbon dioxide building up, emotional distress, or other factors.
• Delirium. The patient’s level of consciousness may change, and they may become restless or incoherent.
• Malnutrition. Patients may eat too little due to anxiety or depression, lack of energy, or lack of appetite caused by discomfort due to breathlessness.
  
• Other chronic diseases including cancer, heart disease, diabetes, kidney disease, and stroke.

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If you live in South Jersey and have questions about end-stage COPD hospice care for your loved one, please call Samaritan at (800) 229-8183.

Samaritan is a member of the National Partnership for Healthcare and Hospice Innovation, a network of not-for-profit hospice and palliative providers across the country. If you know someone outside of our service area who is living with advanced illness and can benefit from hospice or palliative care, please call 1 (844)-GET-NPHI (844-438-6744) for a referral to a not-for-profit provider in your area.

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 Treatments During End-Stage COPD

People with end-stage COPD often prefer to focus on improving their quality of life, rather than seeking invasive measures to prolong life.

Treatment aimed at reducing symptoms and increasing comfort is known as palliative care. A patient can seek palliative care at any time including the day of diagnosis. It addresses the patient’s full range of needs: physical, social, psychological, and spiritual.

Near the end of life, patients can receive hospice care—which is comfort care for people with a life expectancy of six months or less.

Read about the benefits of hospice care at home.

Various treatments can help control symptoms and enhance comfort for people with COPD at the end of life. These therapies can be given by hospice as well as non-hospice providers:

• Inhaled medication to relieve shortness of breath during regular activities
• Medications to reduce airway inflammation and breathlessness
• Oxygen
• Education and exercise for pulmonary rehabilitation
• Nutritional counseling
• Psychological and social support to enhance emotional well being
• Massage, music, and pet therapies
• Relaxation techniques
  

COPD End-of-Life Issues

While no one wants to focus on death, it’s important to plan for end-of-life needs, to help ensure one’s final wishes are met. In fact, advance care planning helps many patients feel better by increasing their sense of control and reducing their fear and anxiety. Here are some key issues to address with a loved one with end-stage COPD:

• Financial and legal matters. Make sure their affairs are in order, including their will, medical and financial power of attorney designees and funeral and burial arrangement plans.
• Advance care plans. Help them create a living will and/or POLST (Practitioner Orders for Life-Sustaining Treatment) to provide instructions for their care at end of life should they become unable to communicate.
• Final wishes. Determine their preferences for their funeral, such as a special reading or music.

For advice on how to have these discussions, visit End-of-Life Conversation Resources.

 

Finally, one of the most important things that family and friends can do is to simply be there for their loved one. Sit with them and share memories. Listen to anything they want to tell you. Hold their hand, play music, or read to them—whatever brings comfort. If you can’t be there in person, call or video chat. Your time and attention are priceless gifts to those with COPD at the end of life.

 

If you live in South Jersey and have questions about end-stage COPD hospice care for your loved one, please call Samaritan at (800) 229-8183.