Respiratory Disease in Palliative Care

Palliative care for advanced respiratory disease in the setting of a primary care team is often concerned with people living with chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD) and in particular idiopathic pulmonary fibrosis (IPF). COPD is the most common of these but is more difficult to identify in its final stages. Palliative care input should therefore be based on current need more so than on prognosis. IPF has a trajectory and prognosis more akin to malignant disease. Although relatively rare in general practice, IPF has a short life expectancy and an easily definable terminal stage, so primary care teams can be alert to the end-of-life care needs of these patients. Individuals living with advanced respiratory disease often want to continue living well in the face of considerable challenges. The task is to develop an approach that ameliorates burdensome symptoms and supports patients and carers, in keeping with their personal objectives and preferences. Information about disease treatments, exacerbations of disease, and the risk of dying is all important. Symptom control using non-pharmacological and pharmacological approaches can enable individuals to continue to participate in activities that are meaningful to them, including toward the end of life.