Hospice Admission Criteria for Panlobular Emphysema

Primary Eligibility Criteria

Patients with panlobular emphysema qualify for hospice admission when they have severe disease with disabling dyspnea at rest, documented disease progression, and a physician-certified prognosis of less than 6 months 1
Disabling dyspnea at rest that significantly limits activity and responds poorly to bronchodilators is a primary eligibility criterion 1, 2
Physician certification by both the treating physician and hospice medical director that prognosis is terminal is required 1, 2
Evidence of disease progression, including two or more exacerbations per year despite adequate treatment, previous hospitalizations for exacerbations, severe airflow obstruction, or hypoxemia at rest or hypercapnia on ambient air, supports eligibility 1, 2

Cor pulmonale, unintentional progressive weight loss greater than 10% over the last 6 months, resting tachycardia greater than 100 beats per minute, requirement for long-term oxygen therapy, and rapidly progressive disease course are factors that support hospice admission 1, 2
Increasing emergency department visits or hospitalizations for respiratory infections and/or respiratory failure also support eligibility 1

Dyspnea management with opioids, oxygen therapy, fans, and positioning is a priority in hospice care 3
Anxiety control with benzodiazepines when dyspnea is associated with anxiety is recommended 3
Secretion management with anticholinergics as death approaches is also important 3
Non-invasive ventilation may be considered for symptom reduction but should not prolong the dying process 4, 5
Open communication about death and preferred place of dying should be part of routine medical consultation with patients who have advanced pulmonary disease 5, 6
Discussions about advance care planning should occur when reduced respiratory reserve is first identified, not delayed until an acute crisis 7