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Key Points

  • Patients with chronic obstructive pulmonary disease (COPD) experience acute exacerbations of their disease, which may produce respiratory failure and a possible need for either ventilatory support or accepting death.
  • No clinical features can identify patients with respiratory failure who will experience more burden than benefit from life supportive care.
  • Healthcare providers should assist patients during stable periods of health to think about their advance care planning by initiating discussions about end-of-life care.
  • These discussions should prepare patients with advanced COPD for a life-threatening exacerbation of their chronic disease while assisting them to go on living and enjoying life.
  • End-of-life discussions and advance care planning assist decisions regarding life-supportive care at the end of life by providing information on probable outcomes and the existence of palliative interventions, such as dyspnoea management and terminal sedation. See FACTORS THAT GUIDE END-OF-LIFE PLANNING.
  • Patients who choose to refuse life supportive care or have it withdrawn require expert delivery of palliative care.
  • Physicians and healthcare systems face challenges to ensure that their patients’ end-of-life wishes and advance care plans made in one clinical setting will be known and honoured during subsequent care, whether at home, in a hospital or in a nursing facility. See HOSPICE SERVICE.

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