End-of-Life With COPD: What to Expect

If your COPD is at end stage, it means your treatments may no longer work or that you may not be able to try other procedures that might extend your life.

This is also called stage IV. You might wonder how close you may be to death, or worried that your final weeks and days might be painful.

Now is the time to talk to your doctors and care team. They can help you understand what to expect and help you make the most of your remaining time.

Symptoms of End-Stage COPD

COPD includes conditions like emphysema and chronic bronchitis. It prevents your lungs from bringing oxygen in and getting rid of carbon dioxide.

If you’re at end stage, you’ll probably feel constantly out of breath and without energy. Flare-ups called exacerbations can come on more often and without warning. These episodes can be deadly. Even if you recover, your lungs may be in worse shape than before.

Signs that your condition is very serious include:

Your doctor can’t say exactly how close you may be to dying. That’s because COPD follows its own path in each person. Still, signs that you’re nearing the end include:

  • Breathlessness even at rest
  • Cooking, getting dressed, and other daily tasks get more and more difficult
  • Unplanned weight loss
  • More emergency room visits and hospital stays
  • Right-sided heart failure due to COPD

End-of-Life Care

This is when palliative (comfort) care can really help. The care team can give you medicine and oxygen to help you breathe more comfortably, provide mental health services, and teach you ways to relax.

Hospice is a type of palliative care for people who have 6 months or less to live. It’s a 24/7 comprehensive care you can get at the hospital, in an assisted living center, or your own home. Hospice also covers medical equipment like wheelchairs and adjustable hospital beds that can be set up in your home. Your doctor can renew hospice if you live longer than 6 months.

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How to Plan for the End

You may feel uncomfortable talking about your death with loved ones. But the conversations may help put everyone’s minds at ease. They also give you a chance to take care of practical matters. Some important questions to discuss include:

Where do you want to spend your final days? Most people want to die at home, but 80% do so in a hospital or nursing home. Consider if you’d want hospice at home. If so, let your family know. Hospice also can help survivors come to terms with their loss when you’re gone.

Do you want life-saving measures? If you collapse at home, do you want emergency medical workers to resuscitate you? Do you want to be on a ventilator if you can’t breathe on your own? An advance directive is a legal document that lists your wishes. It:

  • Names a health care power of attorney to make decisions if you can’t speak for yourself
  • Includes a living will that states your wishes for your power of attorney to follow

Is your will up to date? It’s a good idea to check your will if you haven’t for a while. Or write one if you don’t have one. If you need help, talk to a trusted friend, estate planner, or a lawyer who knows the laws in your state.

What kind of funeral, if any, would you like? Don’t assume that your family knows your wishes for your final arrangements.

Tips for Caregivers

As your loved one nears death, you may notice changes in their physical and mental health. They may sleep more, or talk less and less. Other changes may include:

Trouble eating. Breathlessness and other symptoms can make it hard to swallow. Serve smaller meals and snacks, and check that they’ve swallowed before offering another bite.

Your loved one may stop eating and drinking altogether in the days right before death. This is natural since the body doesn’t need the energy.

Soiling the bed . Muscles that control the bowel and bladder weaken. Your loved one may wet or soil themselves. Ask if they want to use an adult diaper or ask if a catheter can be inserted to drain urine.

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Agitation . Semiconscious dying people can get confused and restless. They may cry out or even try to remove tubes and other medical devices. Medications like morphine may calm them down.

Bruising . As the body slows down, blood may pool and look like dark purple bruises.

Breathing changes . You may notice pauses between breaths or hear a noisy sound when your loved one breathes. This so-called “death rattle” happens if mucous or saliva builds in the back of the throat. The sound may be startling, but doctors don’t believe it causes discomfort.

What Caregivers Can Do

Here are some things that can help ease your loved one’s final days:

Moisten their lips and mouth . Dip a mouth swab into water to help with dryness. These look like tiny sponges attached to a lollipop stick. Use a nonpetroleum-based lip balm to lock in moisture.

Ask what makes them feel better . For instance, gently move their arms and legs to make them more comfortable.

Create a soothing atmosphere . Dim the lights or safely light candles.

It’s believed hearing is the last sense to go before death. So, act as if they can hear you even if they don’t respond.

  • Gently hold their hand and read a favorite poem or religious passage
  • Play some music they love
  • Remind them of funny or touching family memories

You probably will be emotional when your loved one passes. You may feel angry, sad, or numb. You might be relieved that they’re now at peace. Grief is a natural process that takes time. Support groups, grief counselors, and even close friends can make the journey a little easier.

WebMD Medical Reference Reviewed by Melinda Ratini, DO, MS on July 30, 2020

Sources

SOURCES:

British Lung Foundation: “What Are the Physical Signs in the Last Weeks or Days?” “How Do I Care for a Loved One at the End of Life?”

American Lung Association: “Learn about COPD,” “Planning for the Future with COPD,” “Palliative Care and COPD.”

Samaritan Hospice and Palliative Care: “End-Stage COPD: What to Expect at the End of Life.”

Stanford School of Medicine: “Home Hospice: Home Care of the Dying Patient.”

Hospice UK: “Being with Someone When They Die.”

End of Life Washington: “The Symptoms of Dying.”

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