lung and airway disorders
Chronic Obstructive Pulmonary Disease (COPD)
Prognosis and End of Life Issues
COPD itself usually does not cause death or severe symptoms if the person stops smoking at a time when airflow is only mildly obstructed. Continued smoking, however, virtually assures that symptoms will worsen. With moderate and severe airflow obstruction, the prognosis becomes progressively worse. People in advanced stages of COPD are likely to need considerable help with medical care and with activities of daily living. They may, for example, arrange to live on a single floor of their house, eat several small meals each day rather than one large one, and avoid wearing shoes that must be tied. Death may result from respiratory failure, lung cancer, heart disorders (for example, heart failure or heart rhythm abnormalities), pneumonia, pneumothorax, or blockage of the arteries leading to the lungs (pulmonary embolism). People with end-stage disease who develop flare-ups may need a breathing tube and mechanical ventilation. The duration of mechanical ventilation may be prolonged, and some people remain ventilator-dependent until death. It is important for people to consider with their doctors and loved ones whether or not they wish this kind of supportive therapy and to do so before a flare-up occurs. An alternative to this supportive therapy is Pain (and not at prolonging life). The best way to ensure that the person’s wishes regarding prolonged mechanical ventilation are carried out is to prepare an 