Determining prognosis is difficult and survival is variable. The criteria refer to patients with various forms of advanced pulmonary disease.
Patients are considered to be in the terminal stage of pulmonary disease if the following criteria are met.
1. Severe Chronic Lung Disease, as evidenced by
- Disabling dyspnea at rest, poorly responsive or unresponsive to bronchodilators, resulting in decreased functional capacity (bed to chair existence, fatigue, cough). Documentation of FEV1, after bronchodilator, < 30% of predicted, if available
- Progressive pulmonary disease, as evidenced by increasing ED visits or hospitalizations related to pulmonary disease (serial decrease of > 40 ml/ year in FEV1, if available)
2. Hypoxemia at rest, as evidenced by
- pO2 < 55 mmHg on room air
- O2 saturation < 88% on supplemental O2
- Hypercapnia with pCO2 > 50mmHg
May be obtained from recent hospitalizations (3 months)
Other factors that may support hospice eligibility include:
- Right Heart Failure secondary to pulmonary disease (Cor Pulmonale), not heart disease
- Unintentional weight loss of > 10% over past 6 months
- Resting tachycardia > 100/min
**If your patient does not meet the above criteria, they may still qualify for hospice services. Contact the Hospice Care of Kansas location nearest you for assistance in assessing your patient for appropriateness.