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Thursday, April 24, 2014
What to expect?
My mother (86 years old) is suffering from both pulmonary fibrosis and COPD. She is currently under hospice care. She is also very tiny (78 pounds). Can you explain the progression of these two diseases and what I can expect to see happen with her?
COPD (chronic obstructive pulmonary disease) tends to progress more slowly than idiopathic pulmonary fibrosis. Idiopathic pulmonary fibrosis is one of the most common kind of pulmonary fibrosis but not the only kind. Smokers are susceptible to 2 additional types of interstitial lung disease called "desquamative interstitial pneumonitis" and "respiratory bronchiolitis interstitial lung disease". These two conditions tend to progress slower than idiopathic pulmonary fibrosis and can often be suspected based on the appearance of the x-ray or the chest CT scan.
The bottom line is that the progression of the interstital lung disease depends on what type it is. That having been said, when patients have advanced COPD plus interstitial lung disease, especially at an advanced age, the prognosis is usually one of short survival. Patients dying of pulmonary fibrosis or COPD usually do not have pain but can have fairly severe shortness of breath. Hospice is a great idea since the hospice nurses and pharmacists can arrange for opioids (such as morphine) which are very effective at reducing the sense of breathlessness that can occur in terminal stages of lung disease. Oxygen can also be of great help.
James N Allen, Jr, MD
Clinical Professor of Pulmonary, Allergy, Critical Care & Sleep Medicine
College of Medicine
The Ohio State University