Palliative care for advanced pulmonary diseases: A call to action

For patients with advanced pulmonary diseases and their clinicians, value- or goal-concordant care that assesses and alleviates patients’ symptoms and augments quality of life is essential. Chronic pulmonary diseases are a leading cause of morbidity and mortality worldwide. Millions of patients have advanced pulmonary diseases such as COPD and idiopathic pulmonary fibrosis (IPF) in the United States alone. Most of these patients experience burdensome symptoms that degrade their quality of life and limit their lifespan, such as depression, anxiety, social isolation, loneliness, fatigue, breathlessness, cough, and pain. Palliative care in advanced pulmonary disease is proven to help, yet delivery of such care remains a stubbornly pervasive hole in comprehensive pulmonary care. Critical unanswered questions have impeded the successful integration of palliative care. For example, who are the patients most able to benefit from referral to specialty palliative care, recognizing that the specialty palliative care workforce is unable to meet the needs of all patients with needs? How should we, as a professional community, improve the quality of primary (or generalist) palliative care that is delivered by a primary care or pulmonary clinician so that symptoms such as breathlessness can be addressed for every patient with advanced lung disease?

Anne Song, Joanna L Hart