End-of-life Care for Idiopathic Pulmonary Fibrosis Patients with Acute Exacerbation

Overview

Journal Respir Res

Specialty Pulmonary Medicine

Date 2022 Oct 30

PMID 36309741

Authors

Norimichi Akiyama

Tomoyuki Fujisawa

Tatsuya Morita

Takafumi Koyauchi

Yoshinobu Matsuda

Masanori Mori

Mitsunori Miyashita

Ryo Tachikawa

Keisuke Tomii

Hiromi Tomioka

Satoshi Hagimoto

Yasuhiro Kondoh

Yoshikazu Inoue

Takafumi Suda

Affiliations

Soon will be listed here.

Abstract

Background: Acute exacerbation (AE) is a major cause of death in patients with idiopathic pulmonary fibrosis (IPF). AE-IPF patients require optimal palliative care; however, the real-world clinical situations are poorly understood. We aimed to survey the palliative care received by AE-IPF patients, especially with respect to opioid use for dyspnea and the end-of-life discussions (EOLd).

Methods: Self-administered questionnaires were dispatched to 3423 of the certified pulmonary physicians in Japan. They were asked to report a care report form of one patient each with AE-IPF who died very recently about opioid use for dyspnea and EOLd. We further explored the factors associated with the early use of opioids for dyspnea.

Results: Among the 3423 physicians, 1226 (35.8%) returned the questionnaire with the report forms of 539 AE-IPF patients. Of 539 AE-IPF patients, 361 (67.0%) received opioids for dyspnea. Of the 361 patients, 72 (20.0%) received opioids during the initial treatment with an intention of recovery (early use), while 289 (80.0%) did when the recovery was deemed impossible. EOLd was held before the onset of AE in 124 patients (23.0%); however, the majority of patients had EOLd after the admission for AE-IPF. EOLd before the onset of AE was significantly associated with the early use of opioids.

Conclusion: In terminally ill AE-IPF patients, opioids are usually administered when the recovery is deemed impossible, and EOLd are rarely held before the onset of AE. Further studies are warranted on the efficacy of opioids for dyspnea and the appropriate timing of EOLd.

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