The following sources recommend specific thresholds to identify patients with COPD who 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
- 1 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
- 1 episode of assisted ventilation
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 do their usual, necessary daily activities
Adapted from Medscape News & Perspective. Advance Care Planning in Chronic Obstructive Pulmonary Disease: Barriers and Opportunities. Internet. 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.