End-of-Life Strategies among Patients with Advanced Chronic Obstructive Pulmonary Disease

Am J Respir Crit Care Med. 2018 Dec 1;198(11):1389-1396. doi: 10.1164/rccm.201803-0592OC.


Rationale: The burden of advanced chronic obstructive pulmonary disease (COPD) is high globally; however, little is known about how often end-of-life strategies are used by this population.

Objectives: To describe trends in the use of end-of-life care strategies by people with advanced COPD in Ontario, Canada.

Methods: A population-based repeated cross-sectional study examining end-of-life care strategies in individuals with advanced COPD was conducted. Annual proportions of individuals who received formal palliative care, long-term oxygen therapy, or opioids from 2004 to 2014 were determined. Results were age and sex standardized and stratified by age, sex, socioeconomic status, urban/rural residence, and immigrant status. Measurement/Main Results: There were 151,912 persons with advanced COPD in Ontario between 2004 and 2014. Use of formal palliative care services increased 1% per year from 5.3% in 2004 to 14.3% in 2014 (P value for trend < 0.001), whereas use of long-term oxygen therapy increased 1.1% per year from 26.4% in 2004 to 35.3% in 2013 (P value for trend < 0.001). The use of opioids was relatively stable (40.0% in 2004 and 41.8% in 2014; P value for trend = 0.08). Younger individuals were less likely to use formal palliative care services and long-term oxygen therapy. Males were less likely than females to receive long-term oxygen therapy and opioids.

Conclusions: The proportion of people with advanced COPD using end-of-life strategies, although increasing, remains low. Efforts should focus on increasing access to such strategies and educating patients and providers of their benefits.

Keywords: chronic obstructive pulmonary disease; health services; terminal care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Analgesics, Opioid / therapeutic use
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Ontario
  • Oxygen Inhalation Therapy / methods
  • Palliative Care / methods*
  • Pulmonary Disease, Chronic Obstructive / therapy*
  • Terminal Care / methods*


  • Analgesics, Opioid