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(Chest. 2001;120:1043-1044.)
© 2001 American College of Chest Physicians

Dying With Respiratory Disease

Masaaki Sumi, MD; Hiroaki Satoh, MD; Hiroichi Ishikawa, MD; Yuko T. Yamashita, MD and Kiyohisa Sekizawa, MD

University of Tsukuba Ibaraki, Japan

Correspondence to: Hiroaki Satoh, MD, Division of Respiratory Medicine, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-city, Ibaraki, 305-8575, Japan; e-mail: hirosato{at}md.tsukuba.ac.jp

To the Editor:

Since little is known about the symptoms and treatments for dying patients with respiratory diseases, we carried out a chart review for symptoms experienced in the last 2 days of life and the effectiveness of treatment.1 The medical records of 150 sequential patients who died at a respiratory division in an university hospital in April 1994 through December 2000 were reviewed.

The 150 patients who died had an average age of 65 years, and 101 patients (67%) were men. One hundred nine patients had malignancy (lung cancer [n = 104], others [n = 5]), and 41 patients had benign diseases (interstitial pneumonia [n = 19], COPD [n = 11], others [n = 11]). Dyspnea and cough were documented in 69% and 28% of patients with benign disease, respectively. Pain was present in 32% of patients with malignant disease. In patients with benign disease, 59% were receiving ventilatory support, 49% underwent resuscitation, and 63% died in ICUs. On the other hand, patients with malignant disease were less likely to be in ICUs (p = 0.0001, {chi}2 test), to receive ventilatory support (p = 0.0001), or to receive resuscitation (p = 0.0001) compared to those with benign disease.

Our patients had dyspnea more frequently than patients in previous studies1 2 3 4 5 of hopelessly ill patients. This might be explained by the difference in study population. Patients with malignant disease in our series had pain less frequently, which may be due to pain control by appropriate medication. Not a small percentage of our patients with benign disease received life-sustaining treatments. Too often, such treatments are instituted in hospitals, especially in ICUs, without sufficient thought to the proper goals of treatment. Chest physicians are required to formulate an adaptable and flexible treatment plan, tailoring treatment to the patient’s changing needs as the disease progresses.

References

  1. Goodlin, SJ, Winzelberg, GS, Teno, JM, et al (1998) Death in the hospital. Arch Intern Med 158,1570-1572[Abstract/Free Full Text]
  2. Wanzer, SH, Federman, DD, Aderstein, SJ, et al (1989) The physician’s responsibility toward hopelessly ill patients: a second look. N Engl J Med 320,844-849[Abstract]
  3. Fried, TR, Gillick, MR (1994) Medical decision-making in the last six months of life: choices about limitation of care. J Am Geriatr Soc 42,303-307[ISI][Medline]
  4. Lynn, J, Teno, JM (1996) Good care of the dying patient. JAMA 275,474-478[CrossRef][ISI][Medline]
  5. Rummans, TA, Bostwick, JM, Clark, MM (2000) Maintaining quality of life at the end of life. Mayo Clin Proc 75,1305-1310[ISI][Medline]




This Article
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