Palliative Care of Respiratory Disease in Primary Care
The palliative care of advanced progressive respiratory disease in the setting of a primary care team is concerned mainly with chronic obstructive pulmonary disease (COPD), idiopathic pulmonary fibrosis (IPF), and cystic fibrosis (CF). COPD is the commonest of these but it is perhaps the most difficult to identify in its final stages. IPF has a trajectory and prognosis more akin to malignant disease. Though relatively rare in general practice, IPF is the disease among these three that has the most easily definable terminal stage, and so primary care teams should be alert to the palliative care needs of these patients.
CF is a remarkable disease because life expectancy at birth with CF has changed from childhood or teenage years to 30 years now, and for those aged 30 years, life expectancy is now in mid-50s. Like COPD, prognosis in CF is difficult to define. Most people with advanced disease in both groups are living with the disease. Most of these people want to continue living in the face of considerable challenges. The task in both of these diseases is to develop an approach to the amelioration of symptoms and to the support of patients and carers, that is, in keeping with the personal objectives of the patients. Information about treatment, future exacerbations, and the risk of dying is all important. Symptom control is difficult, and for intractable breathlessness, oral morphine has a role in many patients.
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