Recognising advanced disease, advance care planning and recognition of dying for people with COPD

COPD is a common, complex, progressive and incurable disease. Many patients with advanced disease experience debilitating physical, psychological and social impairments over relatively long periods of time. Currently, despite evidence showing that there is a wish and need for advance care planning (ACP), most patients with COPD do not have access to this. While prognosis for the COPD patient is difficult, mortality is high, and patient education regarding the implications of a COPD diagnosis is often lacking but wanted. Potential barriers to the discussion of prognosis include the uncertain illness trajectory in COPD and uncertainty among health professionals as to how to have these discussions. Health professionals need to be aware of the importance of holding these discussions in a timely fashion, and need to prioritise these discussions during routine care. In order to improve the quality of life and reduce the suffering of people with advanced COPD and their families, ACP and palliative care need to be incorporated as part of usual care and earlier into the trajectory of COPD.