End-of-life care for idiopathic pulmonary fibrosis patients with acute exacerbation

Norimichi Akiyama, Tomoyuki Fujisawa, Tatsuya Morita, Takafumi Koyauchi, Yoshinobu Matsuda, Masanori Mori, Mitsunori Miyashita, Ryo Tachikawa, Keisuke Tomii, Hiromi Tomioka, Satoshi Hagimoto, Yasuhiro Kondoh, Yoshikazu Inoue, Takafumi Suda

Research output: Contribution to journalArticlepeer-review


Background: Acute exacerbation (AE) is a major cause of death in patients with idiopathic pulmonary fibrosis (IPF). AE-IPF patients require optimal palliative care; however, the real-world clinical situations are poorly understood. We aimed to survey the palliative care received by AE-IPF patients, especially with respect to opioid use for dyspnea and the end-of-life discussions (EOLd). Methods: Self-administered questionnaires were dispatched to 3423 of the certified pulmonary physicians in Japan. They were asked to report a care report form of one patient each with AE-IPF who died very recently about opioid use for dyspnea and EOLd. We further explored the factors associated with the early use of opioids for dyspnea. Results: Among the 3423 physicians, 1226 (35.8%) returned the questionnaire with the report forms of 539 AE-IPF patients. Of 539 AE-IPF patients, 361 (67.0%) received opioids for dyspnea. Of the 361 patients, 72 (20.0%) received opioids during the initial treatment with an intention of recovery (early use), while 289 (80.0%) did when the recovery was deemed impossible. EOLd was held before the onset of AE in 124 patients (23.0%); however, the majority of patients had EOLd after the admission for AE-IPF. EOLd before the onset of AE was significantly associated with the early use of opioids. Conclusion: In terminally ill AE-IPF patients, opioids are usually administered when the recovery is deemed impossible, and EOLd are rarely held before the onset of AE. Further studies are warranted on the efficacy of opioids for dyspnea and the appropriate timing of EOLd.

Original languageEnglish
Article number294
JournalRespiratory Research
Issue number1
Publication statusPublished - 2022 Dec
Externally publishedYes


  • Acute exacerbation
  • End-of-life discussion
  • Idiopathic pulmonary fibrosis
  • Palliative care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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