The American Thoracic Society has published recommendations for combining palliative with standard care in patients with chronic and advanced respiratory tract illnesses or critical disease.

These recommendations expand palliative care to include all patients with respiratory disease. The complementary recommendations are highlighted below.

Recommendations for doctors and other healthcare professionals

  • Clinicians caring for patients with chronic or advanced respiratory diseases or critical illnesses should be able to provide basic palliative care.
  • Training programs should be available to meet this goal.
  • Consult with palliative care specialists when palliative care needs are greater than the clinician’s level of competence.

Recommendations to manage difficulty breathing

  • Treat psychosocial factors with relaxation techniques, distraction, activity modifications, behavioral modifications, and breathing strategies for anxiety.
  • Add cognitive therapy to antidepressants as needed for depression.

For moderate to severe difficulty in breathing

  • Consider pulmonary rehabilitation, including exercise training, psychosocial support, nutritional therapy, and self-management education for breathing strategies.

For severe difficulty breathing

  • Consider using facial cooling with a fan and noninvasive ventilation.

The statement also provides practical information for clinicians, such as when to consider referral to hospice care and how to withdraw mechanical ventilation.

The bottom line?
Palliative care was once reserved for patients when other treatments were exhausted and death was imminent. Today, it’s considered an integral part of the care that should be available to patients with serious respiratory disorders and critical illnesses.

The recommendations are important. It would be useful if the American Journal of Respiratory and Critical Care Medicine would lighten up a bit and make them available to all healthcare providers instead of their subscribers only or for a fee.

Thanks to Medscape and TherapyTimes for summarizing them.

5//3/08 15:26 JR

Hi, I’m JR

John Russo, Jr., PharmD, is president of The MedCom Resource, Inc. Previously, he was senior vice president of medical communications at, a complementary and alternative medicine website.