Mr R was a 70-year-old man with pulmonary fibrosis and COPD. He was an ex-smoker with a history of ischaemic heart disease. Mr R was on long-term oxygen therapy and had additional oxygen for ambulatory use. In a six-month period, he had three infective exacerbations of his respiratory condition, one of which required hospital admission.
There had been significant deterioration in exercise tolerance and persistent hypoxaemia since his diagnosis seven years previously. He was short of breath at rest and this was compounded by feelings of anxiety. He was becoming increasingly fatigued. On clinical examination he was short of breath with an increased respiratory rate. There were coarse crackles at the lung bases with no wheeze.
Mr R lived with his wife and daughter. He had expressed to his GP his fears in relation to dying. He was particularly concerned about how his wife would cope. Importantly, he felt that he had not previously understood his diagnosis and prognosis prior to his last hospital admission. Recognising deterioration and end-stage respiratory failure were key in this case. Mr R died in the local hospice 3 months later. He chose it as his preferred place of care after visiting it and speaking to the hospice counsellor.