ABSTRACT
Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide. Patients with advanced COPD have considerable palliative care needs, such as high symptom burden, care dependency, impaired quality of life, and advance care planning needs. Moreover, not only the patient, but also the family and significant others have unmet needs. Palliative interventions have positive outcomes for patients, their significant others, health care use and health care costs. Despite this, many patients with advanced COPD do not receive palliative care or only receive it in the dying phase. This chapter provides an overview of palliative care needs of patients with advanced COPD in four domains: physical, psychological, social, and spiritual. The subsequent sections focus on palliative approaches to management of breathlessness including pharmacological and nonpharmacological interventions, management of acute episodes of breathlessness, and the efficacy of breathlessness support services. The final section reviews advance care planning for patients with advanced COPD and their significant others.
