International awareness is growing that patients with COPD need greater access to palliative care services. Various sources have recommended specific thresholds for targeting patients with COPD that need palliative care.
Canadian Thoracic Society guidelines:
Any one of the following:
- FEV1 less than 40%.
- Medical Research Council Dyspnea Scale score of 4 or 5.
- Recurrent severe acute exacerbations requiring hospitalization.
- Poor nutritional status with a BMI less than 19 kg/m2.
Curtis et al.:
Two or more of the following:
- FEV1 less than 30% predicted.
- Oxygen dependence.
- One or more hospital admissions in prior year for exacerbation, left heart failure or other comorbidities.
- Weight loss or cachexia.
- Decreased functional status
- Increasing dependence on others.
- Age more than 70 years.
Partridge et al.:
- The treating physician would not be surprised if the patient died within the next 12 months.
Hardin et al.:
- Global initiative for chronic obstructive lung disease (GOLD) stages II through IV.
- At least two admissions per year for exacerbations.
- BODE index score greater than 5.
- ICU admission for respiratory failure.
- Home noninvasive positive pressure ventilation.
- Supplemental oxygen requirement.
- Patients with more than 10% decrease in body weight in 6 months or BMI less than 21 kg/m2.
- Concomitant congestive heart failure.
- Patients with transplant or lung volume reduction surgery – before or after.
- Lack of home support system.
-Presence of anxiety or depression.
- Patients expressing poor symptom control.
- Patients who are unable to meet their activities of daily living.
Adapted from Medscape News & Perspective. Advance Care Planning in Chronic Obstructive Pulmonary Disease: Barriers and Opportunities. Available at http://www.medscape.com/viewarticle/738113_5. Accessed May 20, 2016. To view the entire article and all other content on the Medscape News and Perspective site, a free, one-time registration is required.