ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a common illness that is incurable, progressive and ultimately fatal. There is a structured integrated care pathway and prescribing guidance for end-stage cancer patients, but the provision of palliative care for COPD patients is currently patchy in most areas. Opioids have been used to treat refractory breathlessness for many years. Consider using oxygen and/or nebulised bronchodilator if bronchospasm is present, and give high-dose diuretic if breathlessness is due to heart failure. Levomepromazine 5 mg subcutaneously for stat and prn use, and 5–10 mg subcutaneously via a syringe driver over a period of 24 hours. Long-term oxygen therapy greater than 15 hours a day can be administered as a palliative treatment for a breathless patient to bring symptomatic relief. Selective serotonin re-uptake inhibitors are beneficial in these patients. Every practice should have an integrated care pathway and a named palliative care nurse.
