Respiratory Disease
What can be expected with advanced COPD?

The Canadian Thoracic Society defines COPD as "a respiratory disorder largely caused by smoking, which is characterized by progressive, partially reversible airway obstruction and lung hyperinflation, systemic manifestations, and increasing frequency and severity of exacerbations".1

Each person’s situation is very different, which makes it difficult to predict the progression of a chronic disease, such as COPD. While it’s impossible to predict accurately the course of the disease, it’s not helpful to be told that “only time will tell.” Some things can be anticipated, and it helps to prepare for them, as well as for the possibility that circumstances may change unexpectedly. A person’s health care team understands the underlying factors in that person’s disease, and can offer useful information about what to expect, and how to prepare for it.

In general, people living with COPD deteriorate physically over time. A decrease in energy and strength is common with progressive diseases. Typically people also experience decreasing capacity for activity, increasing shortness of breath, weight loss, and decreasing blood oxygen levels. It’s important to connect with health care providers to address these symptoms before they become a serious problem, and to ensure that the person remains comfortable throughout the course of the disease. The health care team can help in deciding whether home oxygen is helpful, or if home care assistance is needed. The team can also recommend any medications that may help, such as medications to relieve shortness of breath and to increase comfort.

It’s very difficult to estimate how long someone can live with COPD. Tests such as x-rays, blood gases, or pulmonary function tests can’t predict survival reliably unless the results are very abnormal. If that’s the case then the person’s overall energy and functioning also indicate that death may be near. It’s most informative to consider a guideline called the momentum of change. According to this guideline, if someone’s condition changes significantly from month to month, it’s a strong indication that the person has months left to live. If such changes happen from one week to another, it often means there are only weeks of life left. If there are changes from one day to another or from hour to hour, then there are usually days or hours left. The momentum of change also may take into account the number of hospitalizations in the past months, as well as changes in medications or increase in oxygen requirements. The momentum of change is a general guideline only. Sometimes something happens that causes a person’s condition to change unexpectedly. It’s important to recognize this and prepare for the unexpected.

These steps offer one approach to dealing with the uncertainty in the progression of COPD:

  • Talk with the health care team to get an informed assessment of the patient’s condition.
  • If it’s reasonable to assume that someone has months rather than years of life left, consider planning as if this is the case, even while hoping that there may be more time. Planning in this way allows families and patients to say what they want to say, and do all the things they want to do, whether it’s writing a will, planning a funeral, preparing a journal or writing to family members.
  • Consider preparing a formal health care directive. This document conveys a patient’s wishes for care in the future. The health care team has information that can help in preparing a directive.

Reference:

1. O'Donnell DE, Aaron S, Bourbeau J, et al. Canadian Thoracic Society recommendations for management of chronic obstructive pulmonary disease - 2007 undate. Can Respir J. 2007;14 (Suppl B):5B-32B.

Decisions