Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 16;5(3):00163-2018.
doi: 10.1183/23120541.00163-2018. eCollection 2019 Jul.

Treatment decisions in end-stage COPD: who decides how? A cross-sectional survey of different medical specialties

Martin Gäbler  1   2 , Gerald Ohrenberger  3 , Georg-Christian Funk  4
Affiliations

Treatment decisions in end-stage COPD: who decides how? A cross-sectional survey of different medical specialties

Martin Gäbler et al. ERJ Open Res. .

Abstract

Introduction: End-stage chronic obstructive pulmonary disease (COPD) patients with acute respiratory failure are often treated by representatives from different medical specialties. This study investigates if the choice of treatment is influenced by the medical specialty.

Methods: An online cross-sectional survey among four Austrian medical societies was performed, accompanied by a case vignette of a geriatric end-stage COPD patient with acute respiratory failure. Respondents had to choose between noninvasive ventilation (NIV), a conservative treatment attempt (without NIV) and a palliative approach. Ethical considerations and their impact on decision making were also assessed.

Results: Responses of 162 physicians (67 from intensive care units (ICUs), 51 from pulmonology or internal departments and 44 from geriatric or palliative care) were included. The decision for NIV (instead of a conservative or palliative approach) was associated with working in an ICU (OR 14.9, 95% CI 1.87-118.8) and in a pulmonology or internal department (OR 9.4, 95% CI 1.14-78.42) compared with working in geriatric or palliative care (Model 1). The decision for palliative care was negatively associated with working in a pulmonology or internal department (OR 0.16, 95% CI 0.05-0.47) and (nonsignificantly) in an ICU (OR 0.41, 95% CI 0.15-1.12) (Model 2).

Conclusions: Department association was shown to be an independent predictor for treatment decisions in end-stage COPD with acute respiratory failure. Further research on these differences and influential factors is necessary.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: M. Gäbler has nothing to disclose. Conflict of interest: G. Ohrenberger has nothing to disclose. Conflict of interest: G-C. Funk reports a speaker fee from AstraZeneca, service on an advisory board for GSK, a speaker fee from and service on an advisory board for Boehringer Ingelheim, and a speaker fee from Orion Pharma, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
A typical life trajectory of a chronic obstructive pulmonary disease patient, who experiences a continuous physical decline due to the loss of organ function and comorbidities. Dips in the curve are caused by exacerbations and represent stages of uncertain outcome. Reproduced from [4] with permission.
FIGURE 2
FIGURE 2
Flowchart of data acquisition. #: Austrian Society for Geriatrics and Gerontology n=310, Austrian Society for Internal and General Intensive Care and Emergency Medicine n=812, Austrian Society of Pneumology n=611, and Austrian Palliative Society n=342.
FIGURE 3
FIGURE 3
Treatment decisions in end-stage chronic obstructive pulmonary disease by department affiliation. NIV: noninvasive ventilation. p-value obtained by the Chi-squared test.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Gibson GJ, Loddenkemper R, Lundbäck B, et al. . Respiratory health and disease in Europe: the new European Lung White Book. Eur Respir J 2013; 42: 559–563. - PubMed
    1. Klimathianaki M, Mitrouska I, Georgopoulos D. Management of end-stage chronic obstructive pulmonary disease In: Siafakas NM, ed. Management of Chronic Obstructive Pulmonary Disease (ERS Monograph). Sheffield, European Respiratory Society, 2006; pp. 430–450.
    1. Pavord I, Jones P, Burgel PR, et al. . Exacerbations of COPD. Int J Chron Obstruct Pulmon Dis 2016; 11: 21–30. - PMC - PubMed
    1. Taylor DR, Murray SA. Improving quality of care for end-stage respiratory disease: changes in attitude, changes in service. Chron Respir Dis 2018; 15: 19–25. - PMC - PubMed
    1. Creagh-Brown B, Shee C. Noninvasive ventilation as ceiling of therapy in end-stage chronic obstructive pulmonary disease. Chron Respir Dis 2008; 5: 143–148. - PubMed

LinkOut - more resources