Cuidados paliativos en pacientes con enfermedad pulmonar obstructiva crónica terminal

Abstract

Many guidelines concerning management of COPD have been published, with special emphasis on improving the patients' quality of life. Definitions and ways of achieving this aim are not explained as clear as the guidelines to achieve the rest of the goals. Even in advanced stages of the disease, COPD patients have a better survival nowadays. This fact has led to the appearance of new clinical challenges, such as determining the prognosis and the moment to finish a treatment. This article defines concepts on palliative care and quality of life in terminal COPD patients, pointed out the importance of incorporating them in palliative care programs. It also proposes guidelines to address the topic together with the family. There are many limitations regarding the admission of COPD patients to these programs. An example of these limitations is that predictive models are not individually accurate to establish the exact prognosis of the disease. Also the decision of beginning palliative care to control physical and/or psychological symptoms should be based on the needs of the patient according to his/her expectations, the concept he or she has on life quality and the way his/her family deals with the situation, instead of only considering statistics and their life expectancy. All of this requires a continuous assessment of symptomatology and the gradual incorporation of palliative measures, in addition to the regular treatment of the base disease.