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Papers of the Week

2020 07

J Pain Symptom Manage



Chronic Obstructive Pulmonary Disease: A palliative medicine review of the disease, its therapies and drug interactions.


Weiss A, Porter S, Rozenberg D, O'Connor E, Lee T, Balter M, Wentlandt K
J Pain Symptom Manage. 2020 07; 60(1):135-150.
PMID: 32004618.


Despite significant advances in treatment, chronic obstructive pulmonary disease (COPD) remains a chronic and progressive disease that frequently leads to premature mortality. COPD is associated with a constellation of significant symptoms including dyspnea, cough, wheezing, pain, fatigue, anxiety, depression and insomnia, and is associated with increased morbidity. Palliative care is appropriate to support these patients. However, historically palliative care has focused on supporting patients with malignant disease, rather than progressive chronic diseases such as COPD. Therapies for COPD often result in functional and symptomatic improvements including health-related quality of life (HRQL), and palliative care may further improve symptoms and health related quality of life (HRQL). Provision of usual palliative care therapies for this patient population requires understanding the pathogenesis of COPD and common, disease-targeted pharmacotherapies, as well as an approach to balancing life prolonging and HRQL care strategies. This review describes COPD and current targeted therapies and their effects on symptoms, exercise tolerance, HRQL, and survival. It is important to note that medications commonly used for symptom management in palliative care can interact with COPD medications resulting in increased risk of adverse effects, enhanced toxicity, or changes in clearance of medications. To address this, we review pharmacologic interactions with, and precautions related to use of COPD therapies in conjunction with commonly used palliative care medications.