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The Role of Palliative Care for COPD

By Carole Klingler, BSN, RN and P. Lal Arora, MD, FRCPC

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death in the United States, and the mortality is rising despite new modalities of treatment. The rise is related to the increasing number of women smokers, as well as people who have smoked in the past and are now coming to an age where their disease process is more symptomatic.

Patients may suffer from varying degrees of respiratory distress for years before their ultimate demise. In addition, COPD is frequently a co-morbidity (two or more co-existing medical conditions or disease processes) and can be more symptomatic than the primary diagnosis.

Palliation (to relieve or lessen without curing) of symptoms needs a specialized focus and is often not adequately managed due to the patient’s varied medical care. The result is frequent hospitalizations and visits to the emergency room. COPD patients frequently end up on a ventilator with the expectation they will return to normal daily activities. This is in contrast with the literature which indicates that every visit to the emergency room or ICU and every intubation/ventilator care worsen a patient’s prognosis.

Why isn’t there more help available? There is…

What is Palliative Care?

With the help of medications and other interventions offered by a specialized group of trained personnel, it is now possible to alleviate symptoms, improve quality of life and decrease hospitalizations through palliative care. Palliative care extends the principles of hospice care to a broader population of patients who are not ready for hospice or do not choose it but could benefit from disease management earlier in their illness. Considering the physical and emotional toll symptoms can take, palliative care aims to ease pain, insomnia and shortness of breath, as well as anxiety, depression and other intense emotions.

Palliative care works with curative care, including aggressive treatment or hospitalization if the patient or the family desires. A number of hospice organizations offer palliative care as part of their comfort care. At Hospice of the Western Reserve, we have developed a palliative care team that focuses specifically on the care for patients with COPD.

Our palliative care team members collaborate with patients, families, caregivers, referral sources and other healthcare professionals to provide holistic support for patients They offer support and direction for patients and families interested in advance care planning and ethical wills.

The palliative care team visits patients wherever they call “home.”  This could be a nursing home, assisted living, group home or any other dwelling in our community.

How Palliative Care Works
The palliative care team visits COPD patients wherever they live—whether in an assisted living facility, group home or nursing home. The team has visited patients in prisons and homeless shelters as well. Anyone can receive the supportive services of palliative care.

Palliative care services include:

  • An Advanced Practice Nurse (APN) collaborates with health care workers and use evidence-based symptom control. The APN will also work as a liaison with other specialists (hospitals/community) and provide education for families and caregivers.
  • Assistance with advance health care decision making.
  • Emotional, psychosocial, and spiritual support to the patient and families.
  • Volunteer support, grief counseling, and expressive therapies such as art, music, and legacy work.

Every day, hundreds of people benefit from palliative care. Here’s the story of Mr. J., a COPD patient since 1996 who had been making several trips to the emergency room each year…

Patient File

Mr. J. was first diagnosed with COPD in 1996. At the time, a doctor said he was “worried” about his lungs but Mr. J. did not receive specific information about his condition. Up to that point, Mr. J. had never heard of emphysema or COPD. Over the last two years, his doctors have not felt it was beneficial to continue to test his lung function as it had obviously continued to decline.

In the last 16 months, Mr. J. had been in the emergency room approximately eight times. He was frequently treated with acute measures to improve his shortness of breath. Mr. J. lives about 25 miles from his preferred hospital and this causes a conflict when a crisis occurs. The ambulance drivers are mandated to transport unstable patients to the closest emergency room that can provide treatment. Mr. J. wants to go where the doctors know him, have his records, and treat him with the most effectively.

Through our Palliative Care Program, Hospice of the Western Reserve partnered with Mr. J. and his doctors to manage his pain and other symptoms. By doing so Mr. J was able to recognize and report early symptoms and avoid a crisis and trip to the emergency room.

When should a person with COPD call for Palliative Care?

Any or all of the criteria may be considered.

  • Significant dyspnea and respiratory distress – measured by effect on function (at rest, talking, eating walking etc.) or by other scales available
  • Low body weight and frailty
  • Poor oral intake for calories or fluids
  • Limited activity level due to dyspnea or decreased endurance
  • Decreased mental status, depression or episodes of confusion
  • Onset of edema
  • Age over 70 (male or female)
  • Two or more co-morbid conditions (e.g. Congestive Heart Failure (CHF,) Cancer etc.)
  • Two or more hospitalizations or visits to the emergency room due to exacerbation of COPD in the past year
  • Ventilator support and intubation in the past year
  • Patients with persistent hypoxemia and need for continuous oxygen
  • Patients with persistent respiratory acidosis (pH <7.30)
  • Bed bound status
  • FEV1 <30% predicted
  • Patients on multiple medications

Palliative Care Goals

With the palliative care program, our goal is to compliment the care the patient currently receives, prevent unnecessary hospitalizations, develop communication, and improve the patient’s quality of life. We treat patients and caregivers with respect and dignity at all times, and are always available to answer any questions.

About Hospice of the Western Reserve

Hospice of the Western Reserve is a community-based, non-profit agency providing comfort and emotional support to patients and their families. We care for people in a variety of settings including the home, hospital, long-term care facility, at David Simpson Hospice House overlooking Lake Erie, or at our inpatient Hospice Care Center in Olmsted Township, and soon at Ames Family Hospice House in Westlake. For more information, visit or call 800.707.8922.


  1. Carol
    Posted August 31, 2012 at 4:11 pm | Permalink

    My 90 year old mother was diagnosed with COPD a year ago. She was recently hospitalized with carbondioxide poisoning an is now in a nursing home. There has been confusion; some days worse than others. Today her breathing is significantly worse with increase in fears. The nurse is going to look into meds for anxiety. Is there pallative care for my mother to relieve her dyspnea.

    • ncarlone
      Posted September 4, 2012 at 2:03 pm | Permalink

      Hello Carol,
      I have sent your comment on to our referral office. They will be contacting you within the hour.
      Thank you.

  2. Crystal Harlow
    Posted November 19, 2012 at 8:07 pm | Permalink

    my mother lives in Palm Harbor FL and has end stage copd. Has been on oxygen for 4 years and seems to be at the period where she is needing more care but is still @ home, Is pall. care available in her area?

  3. courtney M
    Posted December 5, 2012 at 9:18 pm | Permalink

    my mom is 70 , quit smoking in 2004 and diagnosed with COPD many years ago. (10 +) SHe is on many medications, eats poorly, on 24 hr oxygen and lives alone. She is frequently depressed becaue of her condition. what can I do. I am a 42 yr divorced mom of a teen boy. She is unable to clean and cook, bue has hired folks to do that. WE live in Howard county ,maryland. ANy ideas or sources to turn to?

  4. Greg
    Posted January 4, 2013 at 11:18 am | Permalink


    My dad is in his final days at home struggling with COPD and CHF.

    He went on a vent and central line due to pneumonia just before christmas and miraculously was off the vent in a week.

    He is now at home with Hospice nurses visiting 2 times a week.

    Yesterday his condition deteriorated as he has both a Urinary Tract infection and possibly pneumonia returned. Running a fever around 100 but on antibiotics and morphine for pain

    He has not had water or food in a day and a half. Still alert and talking yesterday in between periods of sleep. Legs and arms shake.

    How long can we expect him to last?


    • nicolecarlone
      Posted January 7, 2013 at 6:30 pm | Permalink

      Hi Greg, I have forwarded your message on to our clinical staff. Someone will be contacting you today via email. Thank you.

  5. Maria Borrero
    Posted October 8, 2013 at 4:48 pm | Permalink

    I have COPD plus Bronchoecstasis.
    I am 89-1/2 year old. and live in an Independent Living with no family near.
    What do you suggest for me?

  6. Rachel Sheehan
    Posted February 6, 2014 at 6:33 pm | Permalink

    Mom is on 24 oxygen 2 years, multiple medication, frequent chest infections, stage 4 COPD, CHF, poor mobility, overweight, can be confused or lethargic some days, odema in legs/ankles and arms. What would be your advice on this stage of the disease?

    • gcostanzo
      Posted February 7, 2014 at 10:29 am | Permalink

      Hi Rachel,
      I have forwarded your comment to our Clinical Staff. Someone will be contacting you via email to answer your questions. Thank you.

  7. Jackie Pitalo
    Posted July 12, 2014 at 3:42 pm | Permalink

    Hi, My Mom has end stage COPD just recently let out of the hospital after a bad episode! While spending many a day thinking she was going to die the DR then came into the room and suggested hospice care! I was under the impression it’s more about symptom management, what is your thought?

    • Lori Switaj
      Posted July 14, 2014 at 4:41 pm | Permalink

      Jackie, someone from our office will be contacting you shortly.

  8. Deborah haralampopou
    Posted April 28, 2015 at 11:28 am | Permalink

    My 73 yr old mother has copd has had two exhaserbations in 3 months.she cares for my father end stages of Alzheimer’s he is full care patient I’m scared to death she just got out of rehab he is in respite right now she thinks she will get better to bring him home pt said you can’t take care of him homer lift changing feeding what help can she get for herself and him from hospice

    • Lori Switaj
      Posted April 29, 2015 at 8:32 am | Permalink

      Deborah, a member of our referral office (216-383-3700) would like to call you. Can you please provide your phone number to

  9. melanie hall
    Posted September 8, 2015 at 4:25 pm | Permalink

    My mom is 81 years old with COPD and oxygen dependent for 1 year. She has not had any hospitilizations yet, however she is very dyspnic. Very difficult for her to walk across a room, increasingly more short term memory loss and basically homebound. I am so disappointed that her physician has not talked to her about when hospice would be apppropriate. Please help.

    • Lori Switaj
      Posted September 9, 2015 at 8:43 am | Permalink

      We received your comment and someone will be contacting you shortly.

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