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End-of-life needs of COPD patients 'are neglected'

GPs are missing opportunities to prolong or improve the life of one in three patients in the final stages of chronic obstructive pulmonary disease, a Government-funded report has revealed.

The study also found one in five patients was unaware they were about to die from the disease.

The findings have led pulmonary experts to warn the care of COPD patients is suffering as GPs focus on Government health priorities such as coronary heart disease.

GP researcher Dr Patrick White examined illness and health service needs during the final year of life of 209 London COPD sufferers who died from the disease between January and May 2001.

Findings were based on a survey of family and friends of the deceased.

GPs played key roles in repeat prescribing for COPD patients, changing their medication, and referring them to emergency and outpatient care, the study found.

But a third of patients saw their GP less than once every quarter in their final year, although the majority of them suffered constant breathlessness during this period. Some 97 per cent suffered weakness and fatigue and 77 per cent had difficulty sleeping.

Dr White, senior lecturer in general practice at Guy's, King's and St Thomas' School of Medicine and a GP in Norwood, south London, said the study patients 'were isolated and had limited contact with health services despite their advanced disease'.

He added: 'In contrast with advanced cancer, patients who die from COPD appear to

receive no special services to address their end-of-life needs.'

General Practice Airways Group committee member Dr Dermot Ryan said better GP intervention would increase life expectancy and quality in end-stage COPD patients.

'A lot of GPs don't understand there's an awful lot we can do for COPD patients. There is a missed opportunity because patients do need to be fully assessed and do need to have pharmacological intervention,' said Dr Ryan, clinical research fellow at the University of Aberdeen and a GP in Loughborough.

He claimed national service frameworks were drawing away funds.

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