Although end-of-life management strategies are being used more often among patients with advanced chronic obstructive pulmonary disease (COPD), according to the results of a large population-based, repeated cross-sectional study, there appears to be considerable potential to expand the use of these services to meet the needs of this very ill population.

Findings from the study, which was conducted using linked health administrative data from Ontario, Canada, were published in the American Journal of Respiratory and Critical Care Medicine.

Investigators sought to describe trends in the use of end-of-life care strategies in individuals with advanced COPD in Ontario. 

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Annual proportions of patients with COPD who received formal palliative care, long-term oxygen therapy, or opioids between 2004 and 2014 were established. All results were age- and gender-standardized, as well as stratified according to age, sex, socioeconomic status, immigrant status, and urban vs rural residence.

From 2004 to 2014, there were a total of 151,912 individuals with advanced COPD in Ontario. The use of formal palliative care services increased by 1% per year, going from 5.3% in 2004 to 14.3% in 2014 (P value for trend <.001). In addition, the use of long-term oxygen therapy increased by 1.1% per year, going from 26.4% in 2004 to 35.3% in 2013 (P value for trend <.001). The use of opioids, in contrast, was relatively stable, at 40.0% in 2004 and 41.8% in 2014 (P value for trend =.08).

Younger patients were less likely to use formal palliative care services and long-term oxygen therapy compared with older patients. Moreover, men were less likely than women to receive long-term oxygen therapy and opioids.

The investigators concluded that because of the low proportion of individuals with advanced COPD who use end-of-life strategies, efforts need to focus on increasing access to such care, as well as on educating patients and healthcare providers on the benefits of these strategies.

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Gershon AS, Maclagan LC, Luo J, et al. End of life strategies among patients with advanced chronic obstructive pulmonary disease (COPD) [published online June 11, 2018]. Am J Respir Crit Care Med. doi:10.1164/rccm.201803-0592OC