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Pulmonary Fibrosis

Prognosis

06/06/2007

Question:

I have a 75 year old male relative who has pulmonary fibrosis and for the last two & 1/2 months has been in a hospital/skilled care/rehab facility. He first started out in intensive care at one hospital, then moved to a skilled rehab. After 21 days, the skilled center wanted to send him home because they said he could walk 75 ft (not true), so they sent him to another skilled care/rehab center. He has since been receiving between 12 to 15L of oxygen and as of the last few weeks.. constantly on 15L. I have mentioned to his wife about hospice but she feels he will be coming home. While visiting him 2 days ago, he sat on the side of the bed for a few minutes because he wanted to stand up for a moment. When he laid down in bed his oxygen level had dropped to the low 50s and it took about 10 minutes to get it back to 88. The respiratory therapist commented that he usually goes back up to around 93. But not this time. The doctors have not given any prognosis. Do doctors ever see a time where they will say, call hospice? I feel his wife thinks if she asks about hospice it is a sign she is giving up hope. Any advice is greatly appreciated. Thank you in advance for your time.

Answer:

My own philosophy about hospice is that a major purpose of it is to help the patient live as well as possible when faced with a terminal disease. Many people only see hospice as a means to help people die more comfortably, and I believe this is only a part of what hospice does. Idiopathic pulmonary fibrosis is a terminal condition, and hospice can do a great service to patients and families of patients with advanced pulmonary fibrosis.  Hospice helps in terms of assisting in making sure the home environment is equipped to minimize discomfort to the patient and to supply medications that can reduce the sensation of air hunger that often occurs in advanced pulmonary fibrosis. Hospice should not be viewed as giving up - it is always better to get hospice involved earlier rather than later in a patient's illness.

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Response by:

James N Allen, Jr, MD James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University