Supportive and palliative care is an interdisciplinary challenge with the aims of symptom relief and improvement of quality of life in end-stage patients. Main complaints of patients with advanced nonmalignant lung disease are depression and anxiety, dyspnea, pain, and coughing. The discomfort of many physicians, caregivers, and family members with discussions about end-of-life care is one obstacle for the timely initiation of palliative care and the uncertainty of the short-term prognosis in most advanced nonmalignant respiratory diseases. Early dialog about supportive care already at the onset of the patient’s first symptoms and contemporaneous to life-prolonging therapy may overcome these barriers. Furthermore, continuing education for health professionals in palliative care ensures adequate palliative support. Here, we review insights into symptom control and palliative care in patients with advanced nonmalignant respiratory disease.

Keywords:
Supportive care, Palliative therapy, Advanced lung disease, Dyspnea, Cough
1.
Lanken PN, Terry PB, DeLisser HM, Fahry BF, Hansen-Flaschen J, Heffner JE, Levy M, Mularski RA, Osborne ML, Prendergast TJ, Rocker G, Sibbald WJ, Wilfond B, Yankaskas JR: An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses. Am J Respir Crit Care Med 2008;177:912–927.
2.
Post SG, Puchalski CM, Larson DB: Physicians and patient spirituality: professional boundaries, competency, and ethics. Ann Intern Med 2000;132:578–583.
3.
Wright GW, Branscomb BV: Origin of the sensations of dyspnea. Trans Am Clin Climatol Assoc 1966:116–125.
4.
Wasserman K, Cassaburi R: Dyspnea: physiological and pathophysiological mechanisms. Annu Rev Med 1988;39:503–515.
5.
Simon PM, Schwartzstein RM, Weiss JW, LaHive K, Fencl V, Teghtsoonian M, Weinberger SE: Distinguishable sensations of breathlessness in normal volunteers. Am Rev Respir Dis 1989;140:1021–1027.
6.
Mahler DA, Harver A, Lentine T, Scott JA, Beck K, Schwartzstein RM: Descriptors of breathlessness in cardiorespiratory diseases. Am J Respir Crit Care Med 1996;154:1357–1363.
7.
Dyspnea: mechanisms, assessment, and management: a consensus statement. American Thoracic Society Am J Respir Crit Care Med 1999;159:321–340.
8.
Booth S: Management of dyspnoea – oxygen and airflow; in Ahmedzai SH, Muers MF (eds): Supportive Care in Respiratory Disease. Oxford, Oxford University Press, 2005, vol 1, pp 165–188.
9.
Cowcher K, Hanks GW: Long-term management of respiratory symptoms in advanced cancer. J Pain Symptom Manage 1990;5:320–330.
10.
Davis C: Management of dyspnoea – drug therapy; in Ahmedzai SH, Muers MF (eds): Supportive Care in Respiratory Disease. Oxford, Oxford University Press, 2005, vol 1, pp 147–164.
11.
American Thoracic Society: Statement on home care for patients with respiratory disorders. Am J Respir Crit Care Med 2005;171:1443–1464.
12.
Jones PW, Quirk FH, Baveystock CM, Littlejohns P: A self-complete measure of health status for chronic airflow limitation: the St. George’s Respiratory Questionnaire. Am Rev Respir Dis 1992;145:1321–1327.
13.
Twycross R: Symptom Management in Advanced Cancer. Abingdon, Radcliffe Medical Press, 1997.
14.
Barnes PJ: New therapies for chronic obstructive pulmonary disease. Thorax 1993;53:437–447.
15.
Walsh, TD: Opiates and respiratory function in advanced cancer. Recent Results Cancer Res 1984;89:115–117.
16.
Graff GR, Stark JM, Grueber R: Nebulized fentanyl for palliation of dyspnea in a cystic fibrosis patient. Respiration 2004;71:646–649.
17.
Goldsobel AB, Chipps BE: Cough in the pediatric population. J Pediatr 2010;156:352–358.
18.
Chung KF, Pavord ID: Prevalence, pathogenesis, and causes of chronic cough. Lancet 2008;371:1364–1374.
19.
Myers J: Physiology and pathophysiology of cough; in Ahmedzai SH, Muers MF (eds): Supportive Care in Respiratory Disease. Oxford, Oxford University Press, 2005, vol 1, pp 341–364.
20.
Kardos P, Berck H, Fuchs KH, Gillissen A, Klimek L, Morr H, Pfeiffer-Kascha D, Schultze-Werninghaus G, Sitter H, Voshaar T, Worth H: Guidelines of the German Respiratory Society for diagnosis and treatment of adults suffering from acute or chronic cough. Pneumologie 2010;64:336–373.
21.
Morice AH, McGarvey L, Pavord I: Recommendations for the management of cough in adults. Thorax 2006;61(suppl I):i1–i24.
22.
Morice AH: The diagnosis and management of chronic cough. Eur Respir J 2004;24:481–492.
23.
Dicpinigaitis PV, Tso R: Prevalence of depressive symptoms in patients with chronic cough. Proc Am Thorac Soc 2005;2:A520.
24.
Key A, Holt K, Hamilton A, Smith J, Earis J: Objective cough frequency in idiopathic pulmonary fibrosis. Cough 2010;6:4.
25.
Wee B: Chronic cough. Curr Opin Support Palliat Care 2008;2:105–109.
26.
Chung KF: Currently available cough suppressants for chronic cough. Lung 2008;186(suppl 1):S82–S87.
27.
Sevelius H, McCoy JF, Colmore JP: Dose response to codeine in patients with chronic cough. Clin Pharmacol Ther 1971;12:449–455.
28.
Aversa C, Cazzola M, Clini V, Dal Negro R, Maiorano V, Tana F, Allegra L: Clinical trial of the efficacy and safety of moguisteine in patients with cough associated with chronic respiratory diseases. Drugs Exp Clin Res 1993;19:273–279.
29.
Allegra L, Bossi R: Clinical trials with the new antitussive levodropropizine in adult bronchitic patients. Arzneimittelforschung 1988;38:1163–1166.
30.
Smith J, Owen E, Earis J, Woodcock A: Effect of codeine on objective measurement of cough in chronic obstructive pulmonary disease. J Allergy Clin Immunol 2006;117:831–835.
31.
Morice AH, Menon MS, Mulrennan SA, Everett CF, Wright C, Jackson J, Thompson R: Opiate therapy in chronic cough. Am J Respir Crit Care Med 2007;175:312–315.
32.
Hope-Gill BD, Hilldrup S, Davies C, Newton RP, Harrison NK: A study of the cough reflex in idiopathic pulmonary fibrosis. Am J Respir Crit Care Med 2003;168:995–1002.
33.
Horton MR, Danoff SK, Lechtzin N: Thalidomide inhibits the intractable cough of idiopathic pulmonary fibrosis. Thorax 2008;63:749.
34.
Lingerfelt BM, Swainey CW, Smith TJ, Coyne PJ: Nebulized lidocaine for intractable cough near the end of life. J Support Oncol 2007;5:301–302.
35.
Molassiotis A, Smith JA, Bennett MI, Blackhall F, Taylor D, Zavery B, Harle A, Booton R, Rankin EM, Lloyd-Williams M, Morice AH: Clinical expert guidelines for the management of cough in lung cancer: report of a UK task group on cough. Cough 2010;6:9.
36.
Doherty MJ, Mister R, Pearson MG, Calverley PM: Capsaicin responsiveness and cough in asthma and chronic obstructive pulmonary disease. Thorax 2000;55:643–649.
37.
Torrego A, Haque RA, Nguyen LT, Hew M, Carr DH, Wilson R, Chung KF: Capsaicin cough sensitivity in bronchiectasis. Thorax 2006;61:706–709.
38.
Morice AH: The therapy of expectoration; in Ahmedzai SH, Muers MF (ed): Supportive Care in Respiratory Disease. Oxford, Oxford University Press, 2005, vol 1, pp 381–390.
39.
Fuchs HJ, Borowitz DS, Christiansen DH, Morris EM, Nash ML, Ramsey BW, Rosenstein BJ, Smith AL, Wohl ME: Effect of aerosolized recombinant human DNase on exacerbations of respiratory symptoms and on pulmonary function in patients with cystic fibrosis. N Engl J Med 1994;331:637–642.
40.
Eng PA, Morton J, Douglass JA: Short-term efficacy of ultrasonically nebulized hypertonic saline in cystic fibrosis. Pediatr Pulmonol 1996;21:77–83.
41.
Karwa M, Chandra A, Mirza A: Palliative care and chronic obstructive lung disease; in Blank A, O’Mahony S, Selwyn A (eds): Choices in Palliative Care. Springer, 2007, vol 1, pp 99–123.
42.
Schoni MH: Autogenic drainage – a modern approach to physiotherapy in cystic fibrosis. J R Soc Med 1989;82:32–37.
43.
Cherny NI, Ahmedzai SH: Pain in association with respiratory conditions: assessment in research and clinical practive; in Ahmedzai SH, Muers MF (eds): Supportive Care in Respiratory Disease. Oxford, Oxford University Press, 2005, vol 1, pp 427–438.
44.
Ripamonti C, Fulfaro F: Mechanisms of pain associated with respiratory disease; in Ahmedzai SH, Muers MF (eds): Supportive Care in Respiratory Disease. Oxford, Oxford University Press, 2005, vol 1, pp 413–426.
45.
Sobanski P, Zylicz Z: Treating severe pain in advanced lung disease; in Ahmedzai SH, Muers MF (eds): Supportive Care in Respiratory Disease. Oxford, Oxford University Press, 2005, vol 1, pp 439–452.
46.
World Health Organization: WHO’s pain ladder. 2011. http://www.who.int/cancer/palliative/painladder/en/ (accessed July 2, 2011).
47.
Krajnik M, Finlay LG, Zylicz Z: Opioids affect inflammation and the immune system. Pain Rev 1998;5:147–154.
48.
Barker FA: Bronchiectasis. N Engl J Med 2002, 346:1383–1393
49.
Gompelmann D, Eberhardt R, Herth FJF: Advanced malignant lung disease: what the specialist can offer. Respiration 2011;82:111–123.
50.
Au DH, Udris EM, Fihn SD, McDonnell MB, Curtis JR: Differences in health care utilization at the end of life among patients with chronic obstructive pulmonary disease and patients with lung cancer. Arch Intern Med 2006;166:326–331.
51.
Curtis JR: Palliative and end-of-life care for patients with severe COPD. Eur Respir J 2008;32:796–803.
52.
A controlled trial to improve care for seriously ill hospitalized patients: the study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators. JAMA 1995;274:1591–1598.
53.
Aiken LS, Butner J, Lckhart CA, Volk-Craft BE, Hamilton G, Williams FG. Outcome evaluation of a randomized trial of the PhoenixCare intervention: program of case management and coordinated care for the seriously chronically ill. J Palliat Med 2006;9:111–125.
54.
van Ede L, Yzermans CJ, Brouwer HJ: Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax 1999;54:688–692.
55.
Uronis HE, Currow DC, Abernethy AP: Palliative management of refractory dyspnea in COPD. Int J COPD 2006;1:289–304.
56.
Shee CD, Green M: Non-invasive ventilation and palliation: experience in a district general hospital and a review. Palliat Med 2003;17:21–26.
57.
Sciurba FC, Ernst A, Herth FJ, Strange C, Criner GJ, Marquette CH, Kovitz KL, Chiacchierini RP, Goldin J, McLennan G: A randomized study of endobronchial valves for advanced emphysema. N Engl J Med. 2010;363:1233–1244.
58.
Herth FJ, Gompelmann D, Stanzel F, Bonnet R, Behr J, Schmidt B, Magnussen H, Ernst A, Eberhardt R: Treatment of advanced emphysema with emphysematous lung sealant. Respiration 2011;82:36–45.
59.
Palange P: Management of COPD: surgical options. Respiration 2001;68:335–342.
60.
Raghu G, Collard HR, Egan JJ, Martinez FJ, Behr J, Brown KK, Colby TV, Cordier JF, Flaherty KR, Lasky JA, Lynch DA, Ryu JH, Swigris JJ, Wells AU, Ancochea J, Bouros D, Carvalho C, Costabel U, Ebina M, Hansell DM, Johkoh T, Kim DS, King TE Jr, Kondoh Y, Myers J, Müller NL, Nicholson AG, Richeldi L, Selman M, Dudden RF, Griss BS, Protzko SL, Schünemann HJ, ATS/ERS/JRS/ALAT Committee on Idiopathic Pulmonary Fibrosis: An official ATS/ERS/JRS/ALAT statement – idiopathic pulmonary fibrosis: evidence-based guidelines for diagnosis and management. Am J Respir Crit Care Med 2011;183:788–824.
61.
Spruit MA, Janssen DJ, Franssen FM, Wouters FM: Rehabilitation and palliative care in lung fibrosis. Respirology 2009;14:781–787.
62.
Panos RJ, Mortenson RL, Niccoli SA, King TE Jr: Clinical deterioration in patients with idiopathic pulmonary fibrosis: causes and assessment. Am J Med 1990;88:396–404.
63.
Mallick S: Outcome of patients with idiopathic pulmonary fibrosis (IPF) ventilated in intensive care unit. Respir Med 2008;102:1355–1359.
64.
Mollica C, Paone G, Conti V, Ceccarelli D, Schmid G, Mattia P, Perrone N, Petroianni A, Sebastiani A, Cecchini L, Orsetti R, Terzano C: Mechanical ventilation in patients with end-stage idiopathic pulmonary fibrosis. Respiration 2010;79:209–215.
65.
Hassan I: Bronchiectasis. eMedicine Specialties Encyclopedia. Gibraltar, WebMD (accessed June 22, 2007).
66.
Wilson JW, Kotsimbos AT: The management of cystic fibrosis; in Ahmedzai SH, Muers MF (eds): Supportive Care in Respiratory Disease. Oxford, Oxford University Press 2005;1:391–410.
67.
Shoemark A, Ozerovitch L, Wilson R: Aetiology in adult patients with bronchiectasis. Resp Med 2007;101:1163–1170.
68.
Hodson ME, Roberts CM, Butland RJ, Smith MJ, Batten JC: Oral ciprofloxacin compared with conventional intravenous treatment for Pseudomonas aeruginosa infection in adults with cystic fibrosis. Lancet 1987;31:235–237.
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