TY - JOUR T1 - End-of-life care for patients with COPD in the community setting JF - British Journal of General Practice JO - Br J Gen Pract SP - 390 LP - 392 DO - 10.3399/bjgp08X299326 VL - 58 IS - 551 AU - David MG Halpin AU - Clare J Seamark AU - David A Seamark Y1 - 2008/06/01 UR - http://bjgp.org/content/58/551/390.abstract N2 - Chronic obstructive pulmonary disease (COPD) is a common chronic disease which causes significant mortality and morbidity. The chronic nature of the disease results in patients and carers generally living with the illness for longer than patients with a cancer diagnosis. In the earlier stages of the disease, management focuses on improving symptoms and exercise capacity and reducing exacerbations.As the disease progresses, a palliative care approach to symptom control and the adoption of strategies which accept dying as a normal process is appropriate. This should integrate the psychological and spiritual aspects of patient care and offer a support system to help patients live as actively as possible until death.1Altering the paradigm to holistic palliative care as death approaches2 is supported in national guidance from bodies such as NICE,3 but defining when this should take place is difficult and in practice it is usually a gradual transition.4 As a large part of end-of-life care for patients with COPD occurs in the community, it falls to the primary healthcare team with the support of specialist palliative care and secondary care services to provide this integrated care.The best available data suggest there are approximately 900 000 patients diagnosed with COPD in England and Wales,5 and allowing for known levels of under-diagnosis, the true number is likely to be around 2 million.3,5 Over 25 000 people died of COPD in the UK last year,6 representing around 5% of all deaths, but this is likely to be an underestimate.7The challenge for primary care physicians and researchers is making sense of the epidemiology at a practice and individual level in terms of identifying the population with COPD, gauging when a palliative care approach is appropriate, and coordinating services for patients and carers.At … ER -