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Masterclasses                                                               Masterclasses
      HOSPITAL AUTHORITY CONVENTION 2017


             M10.1     Palliative and/or End-of-life Care for Patients with Advanced    09:00  Room 428
                       Chronic Obstructive Pulmonary Disease

            Overall Perspective and Scientific Basis of Palliative Care in Patients with Advanced Chronic Obstructive
            Pulmonary Disease
            Lau KS
            Integrated Medical Service, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong

            Chronic lower respiratory diseases were the sixth leading cause of death in Hong Kong in recent years. Patients with
            advanced chronic obstructive pulmonary disease (COPD) suffer from significant symptoms and impaired quality of life (QOL).
            An early study showed that patients with advanced COPD had worse QOL than patients with advanced lung cancer (Gore,
            2000); and similar findings were reported in recent study (Javadzadeh, 2015).

            A holistic approach is required for care of patients with advanced COPD so as to address disease management; minimise
            physical, psychosocial and spiritual distress; maximise QOL via rehabilitation and palliation; and care for their end-of-life
            journey. Recent international guidelines on COPD have included palliation and care at the end-of-life, which is an integral
            component of care for patients with advanced COPD (GOLD guideline, 2017). Inclusion criteria for palliative care in patients
            with advanced COPD are reported by various respiratory and palliative care professional bodies.
            Canadian guideline on dyspnoea in patients with advanced COPD (CTS 2011) and experts (Mularski and Rocker, 2015)
            recently recommended a triple approach on dyspnea in advanced COPD: (1) disease management; (2) non-pharmacological
            management of dyspnoea; and (3) pharmacological management of dyspnea by using opioids.

            On the aspect of disease management, patients with advanced COPD are classified to the Group D of GOLD guideline. An
            updated GOLD guideline 2017 recommends the use of triple inhaled therapy (LAMA + LABA + ICS), plus options of roflumilast
            and macrolide in Group D patients.

            Non-pharmacological managements on dyspnoea were reviewed by Cochrane review (2011). The positive result of the
            combination of non-pharmacological treatments was reported by a random control trial (RCT) on an integrated palliative
            and respiratory care service of Breathlessness Support Service (BSS) for patients with advanced disease and refractory
            breathlessness (Higginson, 2014). Cost-effectiveness of a Breathlessness Intervention Service (BIS) was supported by an
            RCT (Farquhar, 2016).
            Pharmacological treatment of opioids on dyspnea was recently reviewed by Ekstrom (2015) and Cochrane (2016). The main
            findings are that opioids reduced breathlessness in COPD with the strongest evidence for systemic therapy, whereas there
            were no effects on exercise capacity. No serious adverse effects related to opioids were reported in any study, including no
            reports of hospitalisations, respiratory depression, or carbon dioxide retention (Ekstrom, 2015).

            Advance care planning (ACP) is an important component of care for patient with advanced COPD in addressing patient’s
            preferences on future life-sustaining treatments. A recent RCT showed that a nurse-led facilitated ACP has increased the
            uptake of ACP (Sinclair, 2017).

      Wednesday, 17 May



































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