Download SYMPTOM CONTROL IN END STAGE HEART FAILURE

END STAGE PULMONARY DISEASE (e.g. COPD)
Symptom control for patients with end-stage COPD should continue in conjunction with
optimal COPD treatment. This is the first step to achieving good symptom control. This may
include the use of inhalers, nebulisers, steroids, antibiotics and so on as long as these
medications remain appropriate.
SYMPTOM RELIEF
Breathlessness
 See general palliative care algorithms
 There is evidence that concerns around suppression of respiration are unfounded if
appropriate doses of opioids are used.
Pain

See general palliative care algorithms
Cough
 See general palliative care algorithms
Tenacious sputum
 Mucodyne
 Nebulised saline 0.9%
Nausea and Vomiting
 See general palliative care algorithms
Constipation
 See general palliative care algorithms
Anxiety
 Drug therapies may be helpful to break the anxiety cycle and restore sleep
o Anxiolytics e.g. Lorazepam 0.5mg sublingually for panic attacks
o Night sedation e.g. Lorazepam 0.5 - 1mg nocte
Confusion / Restlessness
 Oxygen may help to reduce confusion secondary to hypoxia
 Haloperidol 1mg tds
END SATGE PULMONARY DISEASE (e.g. COPD)
THE LAST FEW DAYS OF LIFE
It is important to try and recognise patients who appear to be approaching the terminal
phase of their illness. It is more difficult to diagnose dying in COPD than in many terminal
cancer patients.
Indicators
o
o
o
o
of the terminal phase include:
Significant co-morbidity (particularly Cardiac Failure)
Severe COPD – FEV1 < 30% of predicted
No identifiable reversible precipitant
Receiving optimum tolerated conventional drugs
Place of care
If recovery is uncertain, this needs to be shared with patient and family and the patients
wishes explored in terms of options for care and place of care. The most important issue is
likely to be where the patient should be cared for and whether admission is appropriate and
desirable or not.
As the patient becomes weaker and has difficulty swallowing every effort should be made to
continue medication providing symptomatic relief. None essential medications should be
stopped.

Consideration should be given to the advantages / disadvantages of continuing drug
treatments of co-morbidities e.g. hypoglycaemics.

Conversion of oral medication to CSCI via syringe pump may also be indicated. If the
patient is considered to be in the last few days of life conversion of oral analgesia,
antiemetics and anxiolytics to CSCI via syringe pump should be considered with PRN
doses also available (see general palliative care guidelines).

Consideration of sub cutaneous dexamethasone if steroids felt to be of value (750
micrograms dexamethasone~ 5mg prednisolone)

Addition of an anti-secretory agent should also be considered. (see Breathlessness
Algorithm)