COPD: Discussing end-of-life care

Mr R was a 70-year-old man with pulmonary fibrosis and COPD. He was an ex-smoker with a history of ischaemic heart disease. Mr R was on long-term oxygen therapy and had additional oxygen for ambulatory use. In a six-month period, he had three infective exacerbations of his respiratory condition, one of which required hospital admission.

There had been significant deterioration in exercise tolerance and persistent hypoxaemia since his diagnosis seven years previously. He was short of breath at rest and this was compounded by feelings of anxiety. He was becoming increasingly fatigued. On clinical examination he was short of breath with an increased respiratory rate. There were coarse crackles at the lung bases with no wheeze.