By Tim Nuccio and Paul Nuccio, RRT, FAARC

Editor’s Note: Written by RRTs Paul Nuccio and Tim Nuccio, 2009’s “Give Them Comfort: Controlling COPD Symptoms at the End of Life” has consistently been one of RT magazine’s most popular articles, ranking in the top two in online views every month. Ei...

Rising Mortality Rate

According to the Chronic Obstructive Pulmonary Disease Surveillance Report,2 published in the Morbidity and Mortality Weekly Report in 2002, that looked at the mortality rate from the years 1971 through 2000, COPD deaths rose steadily each year. Particularly in...

Assessing the Symptoms

In the final days or hours of patients with COPD, symptoms such as hypersomnolence, disorientation, irregular breathing patterns, mottled skin, cool extremities, reduced production of urine, and generally altered vital signs are all observed. Retained se...

Breathless

According to the National Lung Health Education Program (NLHEP),9 “dyspnea, the sensation of breathlessness or inadequate breathing, is the most common complaint of patients with cardiopulmonary diseases.” Dyspnea occurs when an imbalance exists between the perceived need to breathe and the perceived ability to breathe. It is the “experience” of shortness of breath, and it may or may not be associated with suffering. Dyspnea is often associated with panic and anxiety. The panic may present as dyspnea, while dyspnea may induce panic.When trying to identify dyspnea, oxygen saturation is not a reliable indicator, and a patient’s own report or signs of agitation or anxiety are considered the best means of identifying dyspnea. The patient who is dying of COPD or lung cancer will typically experience a worsening in their dyspnea level as their disease progresses. In addition to the previously discussed panic, fear, and anxiety, patients may also become depressed and angry.Causes of dyspnea in the COPD patient include such things as airway obstruction or restriction, hypoxemia, and deconditioning of the respiratory muscles. Cardiovascular issues such as congestive heart failure or cor pulmonale can also result in dyspnea. Anxiety, fear, anemia, and fluid overload may equally contribute to the symptom. The ability to control dyspnea in end of life COPD patients is of tremendous importance for these patients and their families.

Easing the Symptoms

Pharmacotherapy options for controlling dyspnea vary, depending on the specific cause for the discomfort. Bronchodilators are frequently given to the COPD patient to relieve bronchospasm. For the patient who develops CHF, diuretics can be helpful in re...

Easing the Pain

Pain control can be an issue for these patients, although most pain can be alleviated with medication use. It is best to administer pain medications on a regular basis, as opposed to allowing them to wear off. Waiting until the patients request the me...

Role of Respiratory Therapists

As part of the palliative care process, respiratory therapists may recommend providing, or be requested to provide, oxygen therapy, bronchodilators, secretion clearance techniques, noninvasive ventilation, pulse oximetry and capnography monitoring, as well as communication with the patient and family members. The respiratory therapist is also in a position to provide support and reassuring words, and perhaps even hand-holding, during the final days and hours of the patient’s life. We may be unable to cure these patients of their devastating disease, but we can all play a significant role in the relief of symptoms, and in providing our patients with the respect, care, support, and comfort that they deserve.RTTim Nuccio is an RT student at North Shore Community College in Danvers, Mass. Paul Nuccio, RRT, FAARC, is director of pulmonary services at Brigham and Women’s Hospital in Boston. For further information, contact [email protected].

References