Page 27 - Hospital Authority Convention 2017

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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