COPD as a Life-Limiting Illness: Implications for Advanced Practice Nurses

Donna M. Goodridge, RN, PhD

Disclosures

Topics in Advanced Practice Nursing eJournal. 2006;6(4) 

In This Article

The Burden of COPD

In spite of the fact that chronic circulatory and respiratory conditions engender a significant amount of suffering[1] and cause more deaths among older adults in developed countries than cancer,[2,3] we know very little about the end-of-life care needs of people with advanced, progressive chronic illnesses such as chronic obstructive pulmonary disease (COPD).[4] As COPD progresses, individuals experience significant decreases in functional capacity, quality of life, communication abilities, and psychosocial well-being, impairments that equal or surpass those of persons with cancer.[5] Advanced practice nurses (APNs), particularly those in primary, respiratory, and palliative care, have critical roles to play in identifying and addressing the needs of people with this life-limiting illness.

The purpose of this article is to review the literature relating to end-of-life care for persons with COPD. Two electronic databases — the Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Medline — were searched for articles published from March 1986 to March 2006, using key words. The search strategy used was "chronic obstructive lung disease" OR "chronic obstructive pulmonary disease" AND "end of life care" OR "palliative care" OR "terminal care." In addition, a manual search yielded related publications, including the updated Global Initiative for COPD 2006 guidelines published in November 2006. This article reviews the current state of knowledge regarding the burden of COPD, and the state of end-of-life health services for individuals with COPD.

COPD is currently the fourth leading cause of death in the world, and is projected to become the third most common cause of death by 2015.[6] The economic burden of COPD is immense. In 2003, US healthcare costs related to COPD rose to $31.4 billion, with total costs over the next 20 years estimated to reach about $832.9 billion.[7]

The 5-year mortality rate for people with COPD typically ranges from 40% to 70%, depending on disease severity,[8] while the 2-year mortality rate for people with severe COPD is about 50%.[9,10] Survival rates for people with severe COPD are, in fact, worse than those for people with many common cancers.[11]

The trend in COPD-related mortality differs markedly from that of other chronic diseases. While mortality rates for heart disease and stroke have fallen significantly over the last 30 years (59% to 64% decrease), death rates from COPD have more than doubled, mostly as a result of past smoking history.[12,13]

COPD has also become a significant health concern for women in particular. While the death rate among males has gradually declined, overall COPD mortality rates for females between 1988 and 1999 rose by 53% and continue to escalate.[12] Several factors may account for this increase. Historically, fewer women than men smoked, but that gender gap narrowed gradually until the mid-1980s, when it became fairly constant. Employment in workplaces with occupational exposure to noxious agents, as well as increased exposure to second-hand smoke outside of work, are other factors contributing to this alarming trend.[14] In fact, women with COPD may experience poorer perceptions of health and higher functional limitations than do men,[15,16] although further research is needed in this area.

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