COPD: When is it time to choose hospice care?

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Elderly woman on nebulizer for COPD: When is it time to choose  hospice care?Diseases related to chronic obstructive pulmonary disease, or COPD, make up the fourth highest cause of death in the United States. Yet less than 10 percent of hospice care includes COPD patients. To understand why more don’t take advantage of hospice’s compassionate end-of-life care, we need to take a closer look at this disease.

What is COPD?

COPD is a group of diseases that cause inflammation in the airways and the lungs. The alveoli, or air sacs, collapse and the bronchial tubes stiffen. Inhaling and exhaling is like drinking a thick milkshake through a small straw.

Though the disease is uncurable, with medical and respiratory therapy people can live with COPD for decades. Changes are slow and subtle, so they get accustomed to each stage of decreased abilities. Where once they could climb steps, they need a cane. Where once they could get out of bed without assistance, they need a walker.

From step to step to rapid decline

Patients can continue in this step-down trajectory of managing flare-ups for years. They may not notice they have become less able to recover from each incident. One day, the medical and respiratory therapies that once helped become less effective. This, the fourth stage, comes with chronic fatigue, intractable cough, and often lung infections. It’s no longer a step-down trajectory. It is a continuous and often rapid decline.

We believe and recommend patients in this late stage would benefit from seeking a referral to hospice care. The hospice care team supports patients wherever they call home to help manage symptoms and avoid the trauma of emergency department visits.  Our team includes a physician, nurse, social worker, chaplain and certified nursing assistant and, when available, a volunteer. They are all available to care for the patient and family, physically, emotionally, psychosocially and spiritually.

Answering the why

Monica Ferebee, author of COPD: When is it time for Hospice care?

Monica Ferebee, RN, BSN, MSED CHPN, Clinical Practice Specialist for Nursing

The team plans goals with the patient and family that focus on what the patient wants and needs. And each goal of care answers the “why.” Why give low doses of morphine to a patient? Because it helps them to breathe and is an excellent cough suppressant. Why suggest turning a fan on a patient experiencing shortness of breath? Because it stimulates receptors in a facial nerve that help relieve the feeling of breathlessness.

Choosing quality of life

Choosing hospice care earlier rather than later can help the patient avoid hospitalizations, dealing with complicated medications and traveling to frequent doctor’s visits. It is not giving up on life. It’s choosing a team of experts focused on your quality of your life.


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