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Pulmonary Fibrosis

End Stage & Hospice

12/09/2009

Question:

When a patient in end stage is started medications with hospice to make them comfortable until death what usually happens? Do they go into a coma like state or remain awake until their heart stops or exactly what? My husband is starting this procedure and I do not know what to expect.

Answer:

Hospice is often viewed by patients as a way to make patients comfortable while they are dying. Although this is an important part of hospice, it is not the only thing that hospice can do. We generally use hospice to help patients with terminal diseases live as comfortably as possible in the time that they have remaining and not just to provide care in the final hours of a person's life. Hospice can provide many levels of support, not just medications. It is not euthanasia. 

In patients with pulmonary fibrosis, hospice can arrange for medications to control cough, control anxiety, and control shortness of breath. Hospice can also insure that patients have a proper amount of oxygen to keep them comfortable. Many patients in hospice are able to continue to enjoy family and friends and may be able to get out of the house on occasion. 

We generally start hospice when we believe that a patient has less than 6 months to live. In very late stages of pulmonary fibrosis, when death is eminent, medications are given to help control shortness of breath to prevent a sensation of not being able to get enough air. A common medication used in this situation is morphine - usually the dose is adjusted to relieve shortness of breath without causing unconsciousness. As patients with pulmonary fibrosis get closer to death, the blood carbon dioxide level may rise or the blood oxygen level may fall, resulting in increasing sleepiness and eventually coma. Most of the time, these changes in carbon dioxide and oxygen are due to the disease and not due to the medications used to control uncomfortable symptoms, such as shortness of breath. 

Each hospice can have different philosophies and use different medications. You should speak with the hospice nurse or physician to be sure that both you and the hospice personnel have similar expectations and goals.

For more information:

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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