Effectiveness of palliative symptoms management in end stage Chronic Obstructive Pulmonary Disease

Abstract

Backgrounds: In Chronic Obstructive Pulmonary disease, patients experience a progressively increasing severity of chronic airway obstruction. Gas exchange becomes increasingly impaired even in the absence of noticeable shortness of breath. In the terminal stage, patients develop dyspnea and hypoxemia, leading to chronic tissue oxygen deprivation and respiratory failure. These complications affect daily functioning and exacerbate underlying comorbidities, resulting in prolonged hospital stays, higher medical costs, and potentially life-threatening outcomes.
Objective: The objective was to assess the effectiveness of palliative care interventions in the management of end-stage Chronic Obstructive Pulmonary Disease.
Methods: This study employed a retrospective analytical cross-sectional design, using medical records of 60 patients with Chronic Obstructive Pulmonary Disease who received palliative inpatient care between April 2023 and March 2024. Data were analyzed using descriptive statistics and inferential statistics, including the chi-square test and Fisher’s exact test. Risk factors with statistical significance were identified at a level of p < 0.05.
Results: The study sample consisted of 60 patients. The majority were male (93.3%) and aged between 71 and 80 years (36.7%). Most were married (83.3%) and worked as farmers (73.3%). A body mass index (BMI) of less than 18.5 was observed in 38.3% of the participants. Seventy percent had no comorbidities. A history of smoking was present in 95%, with 66.7% having smoked for more than 10 years. In the past 12 months, 66.7% had a history of hospitalization. The duration of emphysema ranged from 10 to 20 years in 45% of the cases. The time to hospital arrival was less than 30 minutes in 63.3%. And blood oxygen levels were below 90% in 86.7%. Upon admission, 83.3% had a Palliative Performance Scale of 40–60%, and 73.3% presented with confusion. All patients (100%) exhibited dyspnea, fatigue, and anxiety. Chest X-rays showed pulmonary abnormalities in 51.7%. Regarding procedures, most patients did not require intubation (65%). Comorbidities were present in 56.7%. For symptom management, all patients (100%) received short and long-acting bronchodilator inhalers and dexamethasone; 55% received morphine syrup. The length of hospital stay was 1–5 days in 51.6%. Most patients were discharged with clinical improvement 95%.Factors significantly associated with disease severity in COPD patients included initial self-care ability (p < 0.001, odds ratio [OR] 0.035), comorbidities (p = 0.005, OR 5.500), chest X-ray findings (p = 0.003, OR 1.896), initial intubation (p < 0.001, OR 0.009), and the use of symptom management medications at admission, including fentanyl injection (p < 0.001, OR 0.220) and diazepam injection (p < 0.001, OR 0.188).
Conclusions: Outcome of Effectiveness of palliative symptoms management in end stage Chronic Obstructive Pulmonary Disease were the initial functional status, level of consciousness upon admission, comorbid conditions, abnormal chest findings, initial endotracheal intubation, and the use of symptom-management medications at first presentation are all critical factors. Therefore, developing clinical practice guidelines is essential to address the complex needs of these patients comprehensively.