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Masterclasses



                M10.2     Palliative and/or End-of-life Care for Patients with Advanced    09:00  Room 428
                          Chronic Obstructive Pulmonary Disease

               Models and Local Programmes of Palliative Care for Patients with Advanced Chronic Obstructive Pulmonary
               Disease                                                                                             HOSPITAL AUTHORITY CONVENTION 2017
               Ng JSC
               Department of Medicine, Haven of Hope Hospital, Hong Kong

               Chronic obstructive pulmonary disease (COPD) is  a leading cause of mortality and morbidity worldwide. People with
               advanced COPD have obvious palliative care needs. Their quality of life is compromised due to refractory and disabling
               dyspnoea as well as psychosocial impact from the disease. They have poor functional status which goes through a slow
               relentless decline, punctuated with unpredictable life-threatening exacerbations, reflecting the difficulty in prognostication
               and  the  importance  of  early  advance  care  planning (ACP).  However,  in  a  retrospective  study  comparing  non-cancer and
               cancer deaths in Hong Kong (Lau KS at el., 2010), only 3.6% of COPD patients ever received palliative care before death,
               compared with 79.2% of cancer patients. The same study found that in two weeks before death, only around 35% of COPD
               patients ever had ACP documentation in medical record, while such documentation could be identified in more than 60% of
               cancer patients.
               A comprehensive care for patients with advanced COPD should include personalised disease-specific management and
               pulmonary rehabilitation, and should integrate palliative care, which also emphasises early support to family and covers the
               care at the end of life. Such care model requires expertise from both respiratory and palliative medicine, as well as concerted
               effort of an interdisciplinary team. Since 2010, palliative care programmes for non-cancer patients have been developed
               in different Hospital Authority hospitals, including some specifically targeted patients with advanced respiratory diseases.
               In this presentation, overseas care models for patients with advanced COPD would be discussed. There is also sharing on
               local palliative care programmes and the experience on use of opioids for dyspnoea, community support and advance care
               planning in this group of patients.











                M10.3     Palliative and/or End-of-life Care for Patients with Advanced    09:00  Room 428
                          Chronic Obstructive Pulmonary Disease

               Non-pharmacological Treatments of Patients with Advanced Chronic Obstructive Pulmonary Disease
               Chan KCM
               Physiotherapy Department, Ruttonjee and Tang Shiu Kin Hospitals, Hong Kong
               Advanced chronic obstructive pulmonary disease (COPD) is often experienced as a series of ups and downs with lack of
               discrete transition to advanced stage. Patients with advanced COPD are usually suffered from disabling symptoms such
               as refractory breathlessness. It is a subjective experience with complex mechanisms and multiple causes, which could
               be exacerbated by reasons other than mechanical insufficiency of ventilatory system. Breathlessness also has impact on
               patients’ thoughts, which induces stress for both patients and their caregiver.

               Non-pharmacological treatments in multi-disciplinary pulmonary rehabilitation for patients with COPD have proven to improve   Wednesday, 17 May
               patients’ symptoms and function. However, the Chronic Care Model adopted in some pulmonary rehabilitation programmes
               for patients with mild to moderate COPD may not be effective for patients at the advanced stage.

               The transition from rehabilitation to symptomatic control is seamless and could be reversible according to patients’ condition
               and disease progression. Patients with advanced COPD can better benefit from pulmonary rehabilitation if the programme
               focuses on patients’ symptoms, physical function and psychosocial stress. Recent research evidence showed that,
               pulmonary rehabilitation incorporated with Breathlessness Intervention Service Model, which emphasised on breathing,
               thinking and functioning domains, which could effectively manage the disabling symptoms for patients with advanced COPD.
















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