Treatment for End-Stage COPD
- Oral steroids are useful on a short-term basis for moderate and severe exacerbations because they can prevent worsening of COPD. Long-term use of oral steroids should be weighed heavily before prescribing because there are many side effects, such as weight gain, osteoporosis, diabetes, increased risk of infection, and cataracts.
- Theophylline is a low-cost medication, but it can also be fraught with side effects. It works by improving breathing overall and preventing exacerbations. Common side effects include tremors, nausea, headaches, and tachycardia. A low dose should initially be prescribed and increased as needed. When side effects are experienced, it is typically because the dosage is too high.
- Phosphodiesterase-4 inhibitors is a newer drug class that is specific to people with severe COPD. These drugs improve airway inflammation and relax the airways. Weight loss and diarrhea may be experienced. This medication is called roflumilast (Daliresp).
- Antibiotics are used when a lung infection is present. They are not used as a mainstay treatment for COPD. However, according to WebMD, “a recent study shows that the antibiotic azithromycin prevents exacerbations, but it isn't clear whether this is due to its antibiotic effect or its anti-inflammatory properties.”
- Oxygen therapy can also be prescribed for people who need it. Oxygen therapy is used when there is not enough circulating oxygen in the blood. Some people who require supplemental oxygen need it just for sleep, while others will need it all the time. Oxygen therapy can improve quality of life – it extends life for people who need it.
End-Stage COPD and Palliative Care
It is important to understand that COPD is irreversible. It is a leading cause of mortality worldwide.
Unfortunately, the European Respiratory Journal stated in 2008 that, “Despite the high morbidity and mortality associated with severe COPD, many patients receive inadequate palliative care. There are several reasons for this. First, patient-physician communication about palliative and end-of-life care is infrequent and often of poor quality. Secondly, the uncertainty in predicting prognosis for patients with COPD makes communication about end-of-life care more difficult.”
Many people associate the term “palliative care” with “end-of-life” – for some people, this may be the case. However, palliative care does not necessarily mean “hospice.” The World Health Organization defines palliative care as “patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social and spiritual needs and to facilitate patient autonomy, access to information and choice.”
The World Health Organization defines end-of-life care as “care concerning the final stage of life and focuses on care of the dying person and their family.”
Perhaps palliative care and end-of-life care may overlap – but they do not need to initially. By definition, palliative care does envelop end-of-life care, but it also depends on your goals.
Defining your goals for treatment is important. These goals should also be outlined early in the course of your illness so that you have better quality for your end-of-life care.
Tips for Living with End-Stage COPD
Without a doubt, the process will be overwhelming and emotionally draining. Consider these tips for making the best of your experience.
- Get educated – When emotions run high, jumping to conclusions is typical, but try to avoid it. Get information from your doctor or other reputable sources about what your diagnosis means. Stage IV is a wide window of time for many people. Even if the information seems frightening, seek it out. It will provide a framework for your future choices and decisions.
- Set and accomplish goals – Having a terminal diagnosis does not mean that life simply stops. Life goes on for you and the people around you. What do you want to do with the time you have left? If there is something that you always wanted to do or a place you always wanted to go, go for it. Even though your limitations are likely severe at this point, there may be ways to achieve these goals. Don’t let sadness convince you that you should be resigned to spending all day on the couch. Setting goals is a great way to avoid further regrets.
- Grieve and mourn – Grieving is a passive experience that is a reaction to a terminal diagnosis. You cannot force yourself to grieve but you can allow yourself time and the emotional resources needed. You are filling your brain with distractions and diversions delays grieving. Mourning is more active. An example of mourning would be setting aside time to think about aspects of death and dying. Making a list of feelings or fears about dying is an appropriate mourning exercise. These processes are never completed so continue doing what you can to move towards acceptance; with acceptance comes peace.
- Be selfish – The loss process needs to be selfish. You are going through something that others will not understand. Give yourself the freedom to do, think and feel what feels best for you. Assertively communicate your needs to your support system to establish a team approach. As long as your selfishness is in moderation, it will be a positive.
- Be selfless – Now that you have explored being selfish, change gears. Your family, friends, and supports are experiencing changing feelings and thoughts triggered by your stage IV diagnosis. Take time to consider their experience and feelings through empathy. Ask if there are goals or accomplishments they would like to complete. They might feel too uncomfortable to mention it on their own for fear that they would upset you. Remember, death is for the living.
Exercise Can Help
It may sound counterintuitive, but exercise can be very helpful. According to the Cleveland Clinic, utilizing a pulmonary rehabilitation program can “help you learn how to breathe easier and improve your quality of life. It includes breathing retraining, exercise training, education, and counseling.” Ask for a referral to a pulmonary rehabilitation program if you have one locally.
Regular exercise – specifically aerobic exercise, which gets your heart pumping – is beneficial:
- Helps your body use oxygen more efficiently.
- Improves COPD symptoms in general.
- Improves energy levels overall.
- Strengthens the cardiovascular system.
- Lowers blood pressure.
- Increases endurance.
- Improves musculature, flexibility, and balance, which can lessen body weight.
- Improves sleep.
- Mental health benefits, such as reduction in stress, anxiety, and depression, as well as improved self-esteem.
Other Things You Can Do Today
The Centers for Disease Control and Prevention also recommend the following:
- Quitting smoking if you have not done so already.
- Avoiding exposure to secondhand smoke.
- Reviewing the air quality daily. You should stay indoors when the air quality is predicted to be bad.
- Following your physicians’ recommendations for vaccinations – specifically influenza and pneumonia, which can be detrimental to someone with end-stage COPD.
- Take your medications as prescribed. If you’re having a difficult time affording your medications, you should speak with your physician to see if there are alternatives.
The Bottom Line…
Understanding that there are different stages to COPD, as well as the various COPD treatment options, is extremely important. If you have COPD, you should have a frank conversation with your loved ones, as well as your healthcare provider, about your wishes. Doing so can help extend your life, but also ensure that you have the best quality-of-life possible.
