COPD and Death: Managing End of Life Issues

Symptom Control, Signs of Impending Death and What To Do When Death Occurs

Senior man holding hands with senior woman in bed
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If you believe the death of a loved one is approaching due to COPD, it's time to deal with managing their end of life issues.

End of life issues can be difficult to manage, particularly when dealing with a chronic, debilitating illness like chronic obstructive pulmonary disease. To complicate matters, research has shown that in spite of COPD being associated with severe disability and premature death, COPD patients are still receiving inadequate end-of-life care.

For these reasons, you and your family may want to consider enlisting the help of a hospice to guide you through this time.

Whether or not you choose hospice, if your loved one is dying, you probably have a lot of questions about how to provide adequate comfort and support during their final days. This article will answer some frequently asked questions related to end of life.

How Do I Manage My Loved One's COPD Symptoms?

Symptom management is one of the most important aspects of end of life care because COPD symptoms often worsen in the final days.

Common symptoms associated with end of life and COPD include a worsening of dyspnea and cough, increased pain, anxiety and depression, confusion, anorexia and cachexia.

Dyspnea and anxiety have been reported as being the most troublesome COPD symptoms associated with end of life. Controlling these symptoms involves careful assessment and treatment (preferably by your hospice nurse) using a combination of medication and non-medication-related interventions that may include:

  • Bronchodilators - to reduce dyspnea
  • Diuretics - if fluid retention due to related heart problems is worsening dyspnea
  • Opioid narcotics - preferably taken orally or bucally (between the cheek and gums)
  • Oxygen therapy - used carefully and if indicated
  • Glucocorticoids - the drug's negative side effects are no longer a consideration at this stage

Non-medication-related interventions for managing dyspnea that you can implement on your own include:

Pain control is also an issue during the final stages of life with COPD and every effort should be made to alleviate pain. Pain medication should be given around-the-clock to avoid an exacerbation of pain due to the medication wearing off or a delay in administration.

Expectorants and mucolytics do little to relieve a cough during the final phases of COPD. Other methods may provide more effective cough relief, such as:

  • Warm, humidified oxygen or use of a humidifier in the room
  • Opiods, such as codeine or morphine, taken orally
  • Nebulized lidocaine - patients should not eat for at least 30 minutes after administration due to risk of aspiration

    Be sure to talk to your loved one's hospice nurse regarding any medical treatments.

    What If My Loved One Won't Eat?

    It's difficult to watch someone you love refuse life-sustaining nourishment, but this is a very common trait among dying patients. In fact, in the last three days before death, 55 percent of all patients are unable to eat.

    It is advisable, however, to ensure that something else is not contributing to loss of appetite, such as loose-fitting dentures, sores in the mouth, oral thrush, pain or nausea. Here are some tips to be aware of in regard to nutrition and hydration:

    • If your loved one does not feel like eating, don't force them.
    • Offer foods that they enjoy, regardless of nutritional value. If they want ice cream for breakfast, give it to them.
    • Consider enteral tube feeding if this is something that your loved one has expressed a desire for.
    • Provide frequent oral care using moisture swabs and ice chips to avoid oral conditions related to dehydration.

    What If My Loved One Becomes Confused?

    When a COPD patient is terminal, there are a number of factors which may cause confusion:

    Treatment should be directed at the cause if it can be determined. For example, if the underlying cause of confusion is hypoxemia, then supplemental oxygen can be used to correct it; if confusion is related to urinary retention, you can discuss foley catheter placement with your hospice nurse.

    What If My Loved One Gets Depressed?

    The end of a person's life can be a time of deep reflection for both patient and family. It can also be a time of great sadness.

    What can you do to help? Simply holding your loved one's hand and listening may provide the comfort that words cannot. Be sure to address any spiritual needs that your loved one may have. You may even want to ask a priest, pastor or counselor to help. Finally, encourage your loved one to talk about their feelings, and to address any unresolved issues openly and freely.

    How Will I Know When My Loved One's Death from COPD Is Occurring? 

    When death is near, the body naturally begins to shut down. Manifestations of this may include:

    • Increased sleepiness
    • Increased confusion and agitation
    • Visions and hallucinations
    • Unresponsiveness and/or unconsciousness
    • Decreased interest in food or water
    • Withdrawal from others
    • Inability to control bowels and/or bladder
    • Decrease in body temperature; skin feels cold to the touch
    • Dark, concentrated urine; decrease in urine output
    • Increased, uncontrollable pain
    • Irregular breathing patterns
    • Gurgling or other disturbing noises heard when breathing
    • Unintentional movement
    • Changes in blood pressure, respiration and heart rate
    • Loss of reflexes

    What Do I Do Once Death Has Occurred?

    After your loved one has passed, you will undoubtedly feel a number of mixed emotions from relief, to anger, to intense sadness. It's important to understand that these are normal reactions and part of the grieving process. The Palliative Care GuideSite offers a series of articles for those who are left behind that may prove useful, including:

    Survivor's Checklist After Death

    Grief and Mourning: What's Normal, What's Not?

    Letting Go of Grief


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    Helen M. Sorenson MA RRT FAARC. Controlling COPD Symptoms at the End of Life.

    Horfarter B, Weixler D. Symptom control and ethics in final stages of COPD. Wien Med Wochenschr. 2006 May;156(9-10):275-82.

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