Quality of Life Changes Over Time in Patients With Chronic Obstructive Pulmonary Disease

Gary L. Jones

Disclosures

Curr Opin Pulm Med. 2016;22(2):125-129. 

In This Article

End-stage Chronic Obstructive Pulmonary Disease

Although many patients with COPD maintain reasonable levels of function and acceptable HRQoL, a significant portion progress to end-stage disease. An extensive literature exists demonstrating that patients with GOLD stage 3 and 4 COPD experience distressing symptoms and impairment in HRQoL at least as severe as patients with lung cancer,[34–36] but the dyspnea from COPD is more intense and the symptoms occur over a longer period of time. Habraken et al.[37] followed 82 patients with GOLD stage 4 COPD for 5 years, monitoring lung function, HRQoL using SGRQ, and functional status using the Groningen Activities for Daily Living Scale. Although HRQoL and functional status were shown to decline for patients who started with the least impairment, these tests were not sensitive enough to detect changes in those with the most severe disease. An important observation was that even in patients who died during the study, no sudden deterioration in health status was observed. This adds to the literature concerning the relative inability to predict the likelihood of death in patients with COPD. This uncertainty of near-term prognosis inhibits patient–physician communication about palliative care, and when death occurs it often seems unexpected to the family.[38–40] Frequently progression of dyspnea and declining functional status leads to an isolated homebound existence, causing great stress for patients and caregivers, often with insufficient social and psychological support.[41] Rocker et al.[42] convincingly argue for early and sensitive discussions about the uncertain prognosis, initiation of advanced care planning including an action plan for dyspnea crises, and having ongoing discussions about evolving goals of care as the disease progresses.

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