en
Scientific article
English

Can early introduction of palliative care limit intensive care, emergency and hospital admissions in patients with severe chronic obstructive pulmonary disease? a pilot randomized study

Published inRespiration, vol. 97, no. 5, p. 406-415
Publication date2019
Abstract

BACKGROUND: Despite their poor prognosis, patients with severe chronic obstructive pulmonary disease (COPD) have little access to palliative care and tend to have a high rate of hospital and intensive care unit (ICU) admissions during their last year of life. OBJECTIVES: To determine the feasibility of a home palliative care intervention during 1 year versus usual care, and the possible impact of this intervention on emergency, hospital and ICU admissions, survival, mood, and health-related quality of life (HRQL). METHODS: Prospective controlled study of patients with severe COPD (GOLD stage III or IV) and long-term oxygen therapy and/or home noninvasive ventilation and/or one or more hospital admissions in the previous year for acute exacerbation, randomized to usual care versus usual care with add-on monthly intervention by palliative care specialists at home for 12 months. RESULTS: Of 315 patients screened, 49 (15.5%) were randomized (26 to early palliative care; 23 to the control group); aged (mean +/- SD) 71 +/- 8 years; FEV1 was 37 +/- 14% predicted; 88% with a COPD assessment test score > 10; 69% on long-term oxygen therapy or home noninvasive ventilation. The patients accepted the intervention and completed the assessment scales. After 1 year, there was no difference between groups in symptoms, HRQL and mood, and there was a nonsignificant trend for higher admission rates to hospital and emergency wards in the intervention group. CONCLUSION: Although this pilot study was underpowered to formally exclude a benefit from palliative care in severe COPD, it raises several questions as to patient selection, reluctance to palliative care in this group, and modalities of future trials.

Keywords
  • Chronic obstructive pulmonary disease
  • Home noninvasive ventilation
  • Long-term oxygen therapy
  • Palliative care
  • Symptom control
Funding
  • Swiss National Science Foundation - PRN 67 grant 406740_145086
Citation (ISO format)
JANSSENS, Jean-Paul et al. Can early introduction of palliative care limit intensive care, emergency and hospital admissions in patients with severe chronic obstructive pulmonary disease? a pilot randomized study. In: Respiration, 2019, vol. 97, n° 5, p. 406–415. doi: 10.1159/000495312
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Article (Published version)
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ISSN of the journal0025-7931
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