I was wondering if anyone knew much about the management of end stage COPD (Chronic Obstructive Pulmonary Disease.) I understand that it's a progressive condition with no cure - the patient I'm thinking of is 87 with severe COPD/Type II Respiratory Failure - and I've been trying to research the best ways to manage her discomfort and dyspnoea in these last months.. It's getting to the point where she can't walk to the loo (<10m) due to dyspnea (& thus won't), eating worsens her dyspnea ten fold and her sleep is significantly disturbed because she just can't seem to get comfortable.
She has recently moved in with her family because she had a massive decline after the death of her sister. She's had two hospitalisations in about as many months for exacerbations however the medical staff have made it very clear that there are no more medical treatments worth pursuing (she's had two courses of CPAP to bring down her PCO2, however she refuses the mask and it's made little difference to her PCO2, which is sitting around 80.)
She recently implemented home oxygen therapy with an oxygen concentrator at 2L/minute, which relives some of her dyspnea at rest however even eating or moving from sitting up to lying down wear her out. While she's been in hospital we've trialed a course of PRN Zyprexa at night to try and help her sleep (and at one point, relive her agitation when the CPAP was on.) We're hoping to continue this at home because she does not sleep (and thus keeps her family awake at night, calling out every five minutes even though she doesn't want anything.)
Other than regular ventolin (via spacer) and seritide I'm afraid there's little else that's been suggested and I wonder if there are any particular palliative care related interventions which may make her a little more comfortable?