Palliative Approach in Advanced Respiratory Diseases

Main Article Content

Eduardo Borsini
https://orcid.org/0000-0003-2930-6022
Agustín Montes Onganía
https://orcid.org/0000-0002-5437-0715
Mariano De Muria
https://orcid.org/0000-0002-8861-3279
Bárbara Finn
https://orcid.org/0009-0003-0539-2103
Rafael Golpe
https://orcid.org/0000-0002-3759-5322

Abstract

Advanced chronic respiratory diseases are prevalent and cause deterioration in quality of life, particularly chronic obstructive pulmonary disease (COPD), diffuse interstitial lung diseases (ILD) and progressive neuromuscular diseases with diaphragmatic involvement (NMD). 


Those who suffer from them usually present persistent symptoms that are not always adequately controlled by the treatments recommended by the clinical management guidelines. Palliative treatment of persistent symptoms is a relevant point, but the palliative approach usually presents barriers to its implementation.


This article offers a narrative review over Latin American perspective on the role of palliative care in advanced respiratory diseases.

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How to Cite
Borsini, E., Montes Onganía, A., De Muria, M., Finn, B., & Golpe, R. (2023). Palliative Approach in Advanced Respiratory Diseases. Respirar, 15(4). https://doi.org/10.55720/respirar.15.4.5
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Author Biographies

Agustín Montes Onganía, Hospital Británico, Programa de Cuidados Paliativos, Buenos Aires, Argentina.

Medico especialista en Medicina Interna. Staff del programa institucional de cuidados paliativos y fragilidad.

Mariano De Muria, Hospital Británico, Programa de Cuidados Paliativos, Buenos Aires, Argentina.

Médico especialista en medicina interna y cuidados paliativos. Staff del programa de cuidados paliativos y fragilidad.

Bárbara Finn, Hospital Británico, Programa de Cuidados Paliativos, Buenos Aires, Argentina.

Especialista en medicina interna. Jefe del programa de cuidados paliativos y fragilidad. 

Rafael Golpe, Complejo Hospitalario Universitario de Lugo, Hospital Lucus Augusti, Servicio de Neumología, Galicia, Spain.

Médico neumólogo. Docente del Máster Universitario SEPAR-ALAT. Área cuidados paliativos.

References

Radbruch L, De Lima L, Knaul F et al. Redefining Palliative Care-A New Consensus-Based Definition. J Pain Symptom Manage 2020; 60: 754-764. Doi: 10.1016/j.jpainsymman.2020.04.027.

Jacob G. Manual de cuidados paliativos para la atención primaria de la salud. 1a ed. Instituto Nacional del Cáncer. Ciudad Autónoma de Buenos Aires, 2014, pp. 276.

Haun MW, Estel S, Rücker G et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev 2017; 12; 6: CD011129. Doi: 10.1002/14651858.CD011129.pub2.

Lanken PN, Terry PB, Delisser HM et al. ATS End-of-Life Care Task Force. An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008; 5: 177: 912-27. Doi: 10.1164/rccm.200605-587ST.

Murray SA, Kendall M, Grant E, Boyd K, Barclay S, Sheikh A. Patterns of social, psychological, and spiritual decline toward the end of life in lung cancer and heart failure. Journal of Pain and Symptom Management 2007; 34: 393–402. Doi: 10.1016/j.jpainsymman.2006.12.009.

Tripodoro VA, Rynkiewicz MC, Llanos V, Padova S, De Lellis S, De Simone G. Atención paliativa en personas con enfermedades crónicas avanzadas. Medicina (Buenos Aires) 2016; 76: 139-147.

Organización Mundial de la Salud. 67° Asamblea Mundial de la Salud. Documento oficial en español. WHA67/2014/REC/1. [Internet]. [Consultado 6 Mar 2023]. Disponible en:

https://apps.who.int/gb/ebwha/pdf_files/WHA67-REC1/A67_2014_REC1-sp.pdf

Temel JS, Greer JA, Muzikansky A et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. N Engl J Med 2010; 363: 733-742. Doi: 10.1056/NEJMoa1000678.

Ferrel BR, Temel JS, Temin S et al. Integration of Palliative Care into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. Journal of Clinical Oncology 2017; 35: 96-112. Doi: 10.1200/JCO.2016.70.1474.

Gómez-Batiste X, Martínez-Muñoz M, Blay C et al. Identificación de personas con enfermedades crónicas avanzadas y necesidad de atención paliativa en servicios sanitarios y sociales: elaboración del instrumento NECPAL CCOMS-ICO. Med Clin (Barc) 2013; 140: 241-5. Doi: 10.1016/j.medcli.2012.06.027.

Escarrabill J, Soler-Cataluña JJ, Hernández C et al. Normativa SEPAR: recomendaciones sobre la atención al final de la vida en pacientes con EPOC. Arch Bronconeumol 2009; 45: 297–303. Doi: 10.1016/j.arbres.2008.11.005.

Boyd K, Murray S. Recognising and managing key transitions in end-of-life care. BMJ 2010; 341: 649-652. Doi: 10.1136/bmj.c4863.

Lange AV, Mehta AB, Bekelman DB. How Important is Spirometry for Identifying Patients with COPD Appropriate for Palliative Care? J Pain Symptom Manag 2023; 65: 181-e187. Doi: 10.1016/j.jpainsymman.2022.11.016.

Tripodoro VA, Llanos V, De Lellis S, Salazar Güemes C, De Simone GG, Gómez-Batiste X. Prognostic factors in cancer patients with palliative needs identified by the NECPAL CCOMS-ICO© tool. Medicina (B Aires) 2019;79: 95-103.

Tripodoro VA, Llanos V, Daud ML et al. Palliative and prognostic approach in cancer patients identified in the multicentre NECesidades PALiativas 2 study in Argentina. Ecancermedicalscience 2021;10: 16:1316. Doi: 10.3332/ecancer.2021.1316.

Bonilla Sierra P. Cuidados paliativos en Latinoamérica. RNCM 2020; 4 (2). Doi: 10.35454/rncm.v4n2.226.

Almagro P, Yun S, Sangil A et al. Palliative care and prognosis in COPD: a systematic review with a validation cohort. Int J Chron Obstruct Pulmon Dis 2017; 12: 1721-1729. Doi: 10.2147/COPD.S135657.

Brighton LJ, Bone AE, Maddocks M. Supportive and palliative care for people with chronic respiratory disease and frailty. Curr Opin Support Palliat Care 2020; 14: 206-212. Doi: 10.1097/SPC.0000000000000523.

Maddocks M, Lovell N, Booth S, Man WD, Higginson IJ. Palliative care and management of troublesome symptoms for people with chronic obstructive pulmonary disease. Lancet 2017; 2: 390(10098):988-1002. Doi: 10.1016/S0140-6736(17)32127-X.

Kreuter M, Bendstrup E, Russell AM et al. Palliative care in interstitial lung disease: living well. Lancet Resp Med 2017; 5: 968-980. Doi: 10.1016/S2213-2600(17)30383-1.

Tavares N, Jarrett N, Hunt K et al. Palliative and end-of-life care conversations in COPD: a systematic literature review. ERJ Open Res 2017; 3: 00068-2016. Doi: 10.1183/23120541.00068-2016.

Orgel E, McCarter R, Jacobs S. A failing medical educational model: a self-assessment by physicians at all levels of training of ability and comfort to deliver bad news. J Palliat Med 2010; 13: 677-83. Doi: 10.1089/jpm.2009.0338.

Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 2000; 5: 302-11. Doi: 10.1634/theoncologist.5-4-302.

Limón Ramírez E, Meléndez Gracia A, Mújica B. Afrontamiento de las pérdidas en la enfermedad crónica avanzada. En: Monografías SECPAL. Cronicidad avanzada. Inspira Network, Madrid, 2018, pp. 79–82.

Kübler-Ross E. On death and dying. Collier Books/Macmillan Publishing Co., 1970.

Spathis A, Booth S, Moffat C et al. The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease. Prim Care Respir Med 2017; 27: 27. Doi: 10.1038/s41533-017-0024-z.

Lewhtwaite H, Williams G, Baldock KL et al. Systematic Review of Pain in Clinical Practice. Guidelines for Management of COPD: A Case for Including Chronic Pain? Healthcare 2019; 7: 15. Doi: 10.3390/healthcare7010015.

Verberkt CA, van den Beuken-van Everdingen MHJ, Schols JMGA et al. Effect of sustained-release morphine for refractory breathlesness in chronic obstructive pulmonary disease on health status. A randomized clinical trial. JAMA Intern Med 2020; 180: 1306-14. Doi: 10.1001/jamainternmed.2020.3134.

Bach JR. Palliative care becomes ‘uninformed euthanasia’ when patients are not offered noninvasive life preserving options. J Palliat Care 2007; 23:181–184.

Tripodoro VA, De Vito EL. Management of dyspnea in advanced motor neuron diseases. Curr Opin Support Palliat Care 2008; 2:173-9. Doi: 10.1097/SPC.0b013e32830c9049.

Barnes H, McDonald J, Smallwood N, Manser R. Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database Syst Rev 2016; 33:3(3):CD011008. Doi: 10.1002/14651858.CD011008.pub2.

Benítez-Rosario MA, Salinas-Martín A, Feria M. Oral transmucosal fentanyl citrate in the management of dyspnea crises in cancer patients. J Pain Symptom Manage 2005; 30: 395-7. Doi: 10.1016/j.jpainsymman.2005.10.002.

Higginson IJ, Wilcock A, Johnson MJ et al. BETTER-B Feasibility Trial Group. Randomised, double-blind, multicentre, mixed-methods, dose-escalation feasibility trial of mirtazapine for better treatment of severe breathlessness in advanced lung disease (BETTER-B feasibility). Thorax 2020; 75: 176-179. Doi: 10.1136/thoraxjnl-2019-213879.

Simon ST, Higginson IJ, Booth S, Harding R, Weingartner V, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev 2016; 10: Cd007354. Doi: 10.1002/14651858.CD007354.pub3.

Vertigan AE, Kapela SL, Ryan NM, Birring SS, McElduff P, Gibson PG. Pregabalin and speech pathology combination therapy for refractory chronic cough: a randomized controlled trial. Chest 2016; 149:639–48. Doi:10.1378/chest.15-1271.

Ryan NM, Birring SS, Gibson PG. Gabapentin for refractory chronic cough: a randomised, double-blind, placebo-controlled trial. Lancet 2012; 380: 1583–89. Doi: 10.1016/S0140-6736(12)60776-4.

Yohannes AM. Serotonergic antidepressants in COPD: beneficial or harmful? Eur Respir J 2018; 52: 1801095. Doi: 10.1183/13993003.01095-2018.

Ferreira IM, Brooks D, White J, Goldstein R. Nutritional supplementation for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2012;12:CD000998. Doi: 10.1002/14651858.CD000998.pub3.

Weisberg J, Wanger J, Olson J et al. Megestrol acetate stimulates weight gain and ventilation in underweight COPD patients. Chest 2002; 121: 1070–78. Doi: 10.1378/chest.121.4.1070.

Makhadami N, Farooqi M, Thom-Fernandes C, Raghavan NG. Pulmonary rehabilitation in interstitial lung diseases. Curr Opin Pulm Med 2020; 26: 470-6. Doi: 10.1378/chest.121.4.1070.

Bausewein C, Booth S, Gysels M, Higginson I. Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database Syst Rev 2008; 16: CD005623. Doi: 10.1002/14651858.CD005623.pub2.

Abernethy A, McDonald C, Firth A et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a doble-blind, randomised controlled trial. Lancet 2010; 376: 784-793. Doi: 10.1016/S0140-6736(10)61115-4.

Davies JD. Noninvasive respiratory support at the end of life. Respir Care 2019; 64: 701-11. Doi: 10.4187/respcare.06618.

Tripodoro VA, Rabec CA, De Vito EL. Withdrawing noninvasive ventilation at end-of-life care: is there a right time? Curr Opin Support Palliat Care 2019; 13: 344-350. Doi: 10.1097/SPC.0000000000000471.

Rajala K, Lehto JT, Saarinen M et al. End-of-life care of patients with idiopathic pulmonary fibrosis. BMC Palliat Care 2016; 15: 85. Doi: 10.1186/s12904-016-0158-8.

Mi E, Mi E, Ewing G et al. Associations between the psychological health of patients and carers in advanced COPD. Int J Chron Obstruct Pulmon Dis 2017;12:2813-2821. Doi: 10.2147/COPD.S139188.

Figueiredo D, Gabriel R, Jácome C, Cruz J, Marques A. Caring for relatives with chronic obstructive pulmonary disease: how does the disease severity impact on family carers? Aging Ment Health 2014;18:385-93. Doi: 10.1080/13607863.2013.837146.

Strang S, Fährn J, Strang P, Ronstad A, Danielsson L. Support to informal caregivers of patients with severe chronic obstructive pulmonary disease: a qualitative study of caregivers' and professionals' experiences in Swedish hospitals. BMJ Open 2019;9(8):e028720. Doi: 10.1136/bmjopen-2018-028720.

Kupeli N, Candy B, Tamura-Rose G et al. Tools Measuring Quality of Death, Dying, and Care, Completed after Death: Systematic Review of Psychometric Properties. Patient 2019; 12: 183-197. Doi: 10.1007/s40271-018-0328-2.

Mayland CR, Gerlach C, Sigurdardottir K et al. Assessing quality of care for the dying from the bereaved relatives' perspective: Using pre-testing survey methods across seven countries to develop an international outcome measure. Palliat Med 2019; 33: 357-368. Doi: 10.1177/0269216318818299.

Hjorth NE, Hufthammer KO, Sigurdardottir K et al.; ERANet-LAC CODE project group; Core scientific group. Hospital care for the dying patient with cancer: does an advance care planning invitation influence bereaved relatives' experiences? A two country survey. BMJ Support Palliat Care 2021; bmjspcare-2021-003116. Doi: 10.1136/bmjspcare-2021-003116.

Nakken N, Janssen DJA, van den Bogaart EHA. Informal caregivers of patients with COPD: Home Sweet Home? Eur Respir Rev 2015; 24: 498–504. Doi: 10.1183/16000617.00010114.

Surges SM, Garralda E, Jaspers B et al. Review of European Guidelines on Palliative Sedation: A Foundation for the Updating of the European Association for Palliative Care Framework. J Palliat Med 2022; 25:1721-1731. Doi: 10.1089/jpm.2021.0646.

Maglio I, Wierzba SM, Belli L, Somers ME. El derecho en los finales de la vida y el concepto de muerte digna. Rev Am Med Resp 2016; 1: 71-77.

Ley 26529/09, en su versión original y texto actualizado conf. L. 26.742/12. Consultado el 22 marzo 2023. Disponible en: https://www.argentina.gob.ar/normativa/nacional/ley-26529-160432.

Ley 27678 en su versión original. Boletín oficial de la República Argentina. 21/07/2022 N° 56041/22 v. 21/07/2022. [Internet]. [Consultado 22 Mar 2023]. Disponible en: https://www.argentina.gob.ar/normativa/nacional/ley-27678-368373.

Fresquet Febrer JL. Adolphe Gubler y el "Journal de Thérapeutique (1874-1883). Asclepio 1993; 45: 143-186. Doi: 10.3989/asclepio.1993.v45.2.490.