Feature Article

Advanced respiratory disease: managing symptoms in the last years of life

Feature Article

Advanced respiratory disease: managing symptoms in the last years of life

Rebecca Disler, Natasha Smallwood, Jennifer Philip

Figures

© Barry Mason/Alamy Stock Photo model used for illustrative purposes only
© Barry Mason/Alamy Stock Photo model used for illustrative purposes only

Abstract

Symptoms in advanced respiratory disease are varied and commonly include breathlessness, fatigue and cough. Symptom control can be complex and difficult to navigate, particularly in the last few years of life as the disease progresses and patients’ needs escalate. Management is best optimised through holistic approaches, with management of individual symptoms alongside treatment of the underlying disease process.

Key Points

  • Symptoms in advanced respiratory disease are varied, complex and require specific attention to improve patient experiences.
  • Key symptoms include the triad or respiratory cluster of chronic breathlessness, fatigue and cough, as well as depression and anxiety, insomnia, cachexia, pain and dry mouth.
  • Management is best optimised through a holistic approach, with individual symptoms also addressed if they persist despite maximising management of underlying disease.
  • Nonpharmacological interventions for breathlessness, such as mobility aids, activity pacing and breathing training have been shown to have good effect.
  • Low dose opioids may be prescribed for some people with severe chronic breathlessness with the intention of reducing breathlessness to an acceptable level, as complete symptom amelioration is often not possible.
  • The psychological impact of advanced respiratory disease is often overlooked and needs to be directly addressed in best practice care.
  • Early introduction of advance care planning (ACP) offers patients the opportunity to document their care preferences and address evident lack of support for chronic lung disease in the final stages of disease. The conversation around ACP should be ongoing as patients’ preferences evolve throughout disease progression.