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Palliative care for patients with non-malignant end stage respiratory disease
  1. K M HILL,
  2. M F MUERS
  1. Department of Respiratory Medicine
  2. Leeds General Infirmary
  3. Great George Street
  4. Leeds LS1 3EX, UK

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Chronic obstructive pulmonary disease (COPD) is a leading cause of morbidity and mortality in the United Kingdom; 28 000 people in England and Wales died of the disease in 1999, a figure comparable with lung cancer which killed 29 000 people in the same year.1Equal numbers of patients with COPD and lung cancer are therefore experiencing preterminal disease and are likely to require similar medical and social services. The UK Department of Health's expert report published in 19922 advocated the extension of palliative care services to all who need them, whatever their diagnosis. Since then, the availability and provision of holistic supportive care to patients dying from non-malignant disease has become a topical issue for palliative medicine.3 However, while countries such as the USA admit a high proportion of non-cancer patients to hospice inpatient units (30% in 1994–5),4the UK lags far behind, concentrating these services mainly on cancer patients with only a small proportion of hospice inpatients (4% in 1995) suffering from diseases other than cancer.5

Severe COPD and advanced lung cancer are both progressive diseases which are often managed by the same health care professionals such as primary care teams. However, the palliative care needs of patients with these two diseases have never previously been compared. The publication of the paper by Gore et al in this issue of Thorax is therefore of interest because it provides further evidence that the care needs of patients with severe COPD should be considered in the same way as those with lung cancer.6 This is an important message for medical practice where the relevance of palliative care skills to patients with terminal non-malignant conditions is recognised but where the framework for extending these services beyond cancer patients is still in need of development.7

The aim …

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