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"&amp;lt;p&amp;gt;If you believe the death of a loved one is approaching due to COPD, it&amp;amp;#39;s time to deal with managing their end of life issues.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;End of life issues can be difficult to manage, particularly when dealing with a chronic, debilitating illness like chronic obstructive pulmonary disease.\u00A0To complicate matters, research has shown that in spite of &amp;lt;a href=&amp;quot;https://www.verywell.com/what-is-copd-914695&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;1&amp;quot;&amp;gt;COPD&amp;lt;/a&amp;gt; being associated with severe disability and premature death, COPD patients are still receiving inadequate end-of-life care.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;For these reasons, you and your family may want to consider enlisting the help of a &amp;lt;a href=&amp;quot;https://www.verywell.com/what-is-hospice-care-1132618&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;2&amp;quot;&amp;gt;hospice&amp;lt;/a&amp;gt; to guide you through this time.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;Whether or not you choose hospice, if your loved one is dying, you probably have a lot of questions about how to provide adequate comfort and support during their final days. This article will answer some frequently asked questions related to end of life.&amp;lt;/p&amp;gt;&amp;lt;h3&amp;gt;How Do I Manage My Loved One&amp;amp;#39;s COPD Symptoms?&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;Symptom management is one of the most important aspects of end of life care because &amp;lt;a href=&amp;quot;https://www.verywell.com/copd-symptoms-915030&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;3&amp;quot;&amp;gt;COPD symptoms&amp;lt;/a&amp;gt; often worsen in the final days.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;Common symptoms associated with end of life and COPD include a worsening of &amp;lt;a href=&amp;quot;https://www.verywell.com/dyspnea-meaning-causes-symptoms-914898&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;4&amp;quot;&amp;gt;dyspnea&amp;lt;/a&amp;gt; and &amp;lt;a href=&amp;quot;https://www.verywell.com/chronic-cough-914895&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;5&amp;quot;&amp;gt;cough&amp;lt;/a&amp;gt;, increased pain, anxiety and depression, confusion, &amp;lt;a href=&amp;quot;https://www.verywell.com/symptoms-of-emphysema-914851&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;6&amp;quot;&amp;gt;anorexia&amp;lt;/a&amp;gt;\u00A0and &amp;lt;a href=&amp;quot;https://www.verywell.com/understanding-cachexia-symptoms-causes-and-treatments-2249008&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;7&amp;quot;&amp;gt;cachexia&amp;lt;/a&amp;gt;.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Dyspnea and anxiety&amp;lt;/strong&amp;gt; have been reported as being the most troublesome COPD symptoms associated with end of life. Controlling these symptoms involves careful assessment and treatment (preferably by your hospice nurse) using a combination of medication and non-medication-related interventions that may include:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/bronchodilators-in-the-treatment-of-copd-914846&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;8&amp;quot;&amp;gt;Bronchodilators&amp;lt;/a&amp;gt;\u00A0- to reduce dyspnea&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Diuretics - if fluid retention due to related heart problems is worsening dyspnea&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/what-are-opiates-2795406&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;9&amp;quot;&amp;gt;Opioid narcotics&amp;lt;/a&amp;gt; - preferably taken orally or bucally (between the cheek and gums)&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/facts-about-oxygen-therapy-914699&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;10&amp;quot;&amp;gt;Oxygen therapy&amp;lt;/a&amp;gt; - used carefully and if indicated&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/pros-and-cons-of-glucocorticoids-914847&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;11&amp;quot;&amp;gt;Glucocorticoids&amp;lt;/a&amp;gt; - the drug&amp;amp;#39;s negative side effects are no longer a consideration at this stage&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/the-benzodiazepines-378909&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;12&amp;quot;&amp;gt;Benzodiazapines&amp;lt;/a&amp;gt; - for relief of anxiety&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/bipolar-medications-4014103&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;13&amp;quot;&amp;gt;Thorazine&amp;lt;/a&amp;gt; - an antipsychotic drug used for severe agitation&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Non-medication-related interventions&amp;lt;/strong&amp;gt; for managing dyspnea that you can implement on your own include:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;Elevating the head of the patient&amp;amp;#39;s bed at least 30 degrees&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Using a gentle fan directed toward the patient&amp;amp;#39;s face&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/how-do-i-perform-pursed-lip-breathing-914882&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;14&amp;quot;&amp;gt;Pursed-lip breathing&amp;lt;/a&amp;gt;&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/visualization-for-relaxation-p2-1945354&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;15&amp;quot;&amp;gt;Relaxation and visualization&amp;lt;/a&amp;gt; techniques&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Therapeutic massage&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/how-and-why-music-therapy-is-effective-3145190&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;16&amp;quot;&amp;gt;Music therapy&amp;lt;/a&amp;gt; with live instruments, CD or radio&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Pain control&amp;lt;/strong&amp;gt; is also an issue during the final stages of life with COPD and every effort should be made to alleviate pain. Pain medication should be given around-the-clock to avoid an exacerbation of pain due to the medication wearing off or a delay in administration.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/definition-of-expectorants-914780&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;17&amp;quot;&amp;gt;Expectorants&amp;lt;/a&amp;gt; and &amp;lt;a href=&amp;quot;https://www.verywell.com/mucolytics-definition-and-example-copd-914793&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;18&amp;quot;&amp;gt;mucolytics&amp;lt;/a&amp;gt; do little to &amp;lt;strong&amp;gt;relieve a cough&amp;lt;/strong&amp;gt; during the final phases of COPD. Other methods may provide more effective cough relief, such as:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;Warm, humidified oxygen or use of a humidifier in the room&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Opiods, such as codeine or morphine, taken orally&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Nebulized lidocaine - patients should not eat for at least 30 minutes after administration due to risk of aspiration&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;p&amp;gt;Be sure to talk to your loved one&amp;amp;#39;s hospice nurse regarding any medical treatments.&amp;lt;/p&amp;gt;&amp;lt;h3&amp;gt;What If My Loved One Won&amp;amp;#39;t Eat?&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;It&amp;amp;#39;s difficult to watch someone you love refuse life-sustaining nourishment, but this is a very common trait among dying patients. In fact, in the last three days before death, 55 percent of all patients are unable to eat.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;It is advisable, however, to ensure that something else is not contributing to loss of appetite, such as loose-fitting dentures, sores in the mouth, oral thrush, pain or nausea. Here are some tips to be aware of in regard to nutrition and hydration:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;If your loved one does not feel like eating, don&amp;amp;#39;t force them.&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Offer foods that they enjoy, regardless of nutritional value. If they want ice cream for breakfast, give it to them.&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Consider &amp;lt;a href=&amp;quot;https://www.verywell.com/enteral-nutrition-or-tube-feeding-2507063&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;19&amp;quot;&amp;gt;enteral tube feeding&amp;lt;/a&amp;gt; if this is something that your loved one has expressed a desire for.&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Provide frequent oral care using moisture swabs and ice chips to avoid oral conditions related to dehydration.&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;h3&amp;gt;What If My Loved One Becomes Confused?&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;When a COPD patient is terminal, there are a number of factors which may cause confusion:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;medications&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/description-of-hypoxia-914905&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;20&amp;quot;&amp;gt;hypoxia&amp;lt;/a&amp;gt;&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;uncontrolled pain&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;lack of sleep&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/what-to-do-if-you-cant-urinate-after-surgery-3157318&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;21&amp;quot;&amp;gt;urinary retention&amp;lt;/a&amp;gt;&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;physiological imbalances&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;p&amp;gt;Treatment should be directed at the cause if it can be determined.\u00A0For example, if the underlying cause of confusion is hypoxemia, then supplemental oxygen can be used to correct it; if confusion is related to urinary retention, you can discuss &amp;lt;a href=&amp;quot;https://www.verywell.com/interstitial-brachytherapy-430387&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;22&amp;quot;&amp;gt;foley catheter&amp;lt;/a&amp;gt; placement with your hospice nurse.&amp;lt;/p&amp;gt;&amp;lt;h3&amp;gt;What If My Loved One Gets Depressed?&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;The end of a person&amp;amp;#39;s life can be a time of deep reflection for both patient and family. It can also be a time of great sadness.&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;What can you do to help? Simply holding your loved one&amp;amp;#39;s hand and listening may provide the comfort that words cannot. Be sure to address any spiritual needs that your loved one may have. You may even want to ask a priest, pastor or counselor to help. Finally, encourage your loved one to talk about their feelings, and to address any unresolved issues openly and freely.&amp;lt;/p&amp;gt;&amp;lt;h3&amp;gt;How Will I Know When My Loved One&amp;amp;#39;s Death from COPD Is Occurring?\u00A0&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;When death is near, the body naturally begins to shut down. Manifestations of this may include:&amp;lt;/p&amp;gt;&amp;lt;ul&amp;gt;&amp;lt;li&amp;gt;Increased sleepiness&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Increased confusion and agitation&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Visions and hallucinations&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Unresponsiveness and/or unconsciousness&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Decreased interest in food or water&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Withdrawal from others&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Inability to control bowels and/or bladder&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Decrease in body temperature; skin feels cold to the touch&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Dark, concentrated urine; decrease in urine output&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Increased, uncontrollable pain&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Irregular breathing patterns&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Gurgling or other disturbing noises heard when breathing&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Unintentional movement&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Changes in blood pressure, respiration and heart rate&amp;lt;/li&amp;gt;&amp;lt;li&amp;gt;Loss of reflexes&amp;lt;/li&amp;gt;&amp;lt;/ul&amp;gt;&amp;lt;h3&amp;gt;What Do I Do Once Death Has Occurred?&amp;lt;/h3&amp;gt;&amp;lt;p&amp;gt;After your loved one has passed, you will undoubtedly feel a number of mixed emotions from relief, to anger, to intense sadness. It&amp;amp;#39;s important to understand that these are normal reactions and part of the grieving process. The\u00A0&amp;lt;a href=&amp;quot;https://www.verywell.com/end-of-life-4014730&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;23&amp;quot;&amp;gt;Palliative Care GuideSite&amp;lt;/a&amp;gt; offers a series of articles for those who are left behind that may prove useful, including:&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/survivors-checklist-after-death-1132601&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;24&amp;quot;&amp;gt;Survivor&amp;amp;#39;s Checklist After Death&amp;lt;/a&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/grief-and-mourning-process-1132545&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;25&amp;quot;&amp;gt;Grief and Mourning: What&amp;amp;#39;s Normal, What&amp;amp;#39;s Not?&amp;lt;/a&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;a href=&amp;quot;https://www.verywell.com/letting-go-of-grief-1132548&amp;quot; data-component=&amp;quot;link&amp;quot; data-source=&amp;quot;inlineLink&amp;quot; data-type=&amp;quot;internalLink&amp;quot; data-ordinal=&amp;quot;26&amp;quot;&amp;gt;Letting Go of Grief&amp;lt;/a&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Sources:&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Curtis JR. Palliative and end-of-life care for patients with severe COPD. Eur Respir J. 2008 Sep;32(3):796-803. Epub 2007 Nov 7.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Helen M. Sorenson MA RRT FAARC. Controlling COPD Symptoms at the End of Life.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;&amp;lt;p&amp;gt;&amp;lt;sub&amp;gt;Horfarter B, Weixler D. Symptom control and ethics in final stages of COPD. Wien Med Wochenschr. 2006 May;156(9-10):275-82.&amp;lt;/sub&amp;gt;&amp;lt;/p&amp;gt;"^^<http://www.w3.org/2001/XMLSchema#string>
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