Improving quality of life for patients with terminal respiratory disease.

Chronic respiratory disease is an increasingly prevalent cause of life-limiting illness. Care for patients with terminal respiratory diseases has historically focused on disease-modifying therapies, many of which have little impact on life expectancy. This exclusive focus can detract from attention to patient-physician communication, advance care planning and palliative treatment strategies. Such shortcomings are exacerbated by the prognostic uncertainty inherent in many noncancer diagnoses. With relatively indeterminate prognosis, many clinicians are reluctant to address goals of care and to consider palliative strategies. Unfortunately, the symptom burden caused by terminal respiratory diseases is high, particularly with regard to dyspnea, pain and psychiatric symptoms such as depressed mood and anxiety. In being willing to address goals of care with seriously ill patients, and to include a focus on symptom management in patients' care plans, regardless of concomitant disease-modifying strategies, providers can better address the needs of patients with serious, life-limiting respiratory illnesses.