Respiratory (Palliative Care)

Information

All patients with advanced progressive respiratory disease (including COPD, interstitial disease, bronchiectasis, respiratory failure and cancer) reach a stage of illness where comfort and symptom management become increasingly important and disease modifying treatment less important

Palliative care can also contribute towards helping a patient adjust their treatment goals and make plans for anticipated deterioration

This change in focus is often supported by primary care teams but may be enhanced by palliative care referral especially for patients with complex symptoms or other needs.

Who to refer:

Patients in palliative phase of illness (the “surprise” question – would you be surprised if the patient died in the next 12 months?)
Two or more of the following:
- Severe airways obstruction (FEV1 < 30%) or restrictive
- Deficit (vital capacity < 60%, transfer factor < 40%)
- Meets criteria for long term oxygen therapy (PaO2 < 7.3 kPa)
- Breathless at rest or on minimal exertion between exacerbations
- Persistent severe symptoms despite optimal tolerated therapy
- Symptomatic right heart failure
- Low body mass index (< 21)
- More emergency admissions (> 3) for infective exacerbations or respiratory failure in past year.