COVID-19 vs Primary Lung Disease: Comparison of Symptom Management Requirements at End of Life

ABSTRACT

Background/aims: In early 2020 as the COVID-19 (C-19) pandemic hit the UK, it was anticipated patients dying of C-19 would experience severe and distressing symptoms at end of life. Specific guidance was developed, in addition to established Scottish Palliative Care Guidelines, to advise on managing symptoms of those imminently dying of C-19. We sought to determine whether medications administered to those dying of C-19 differed to those administered to those dying of other primary lung disease (PLD). Methods: Case notes and electronic prescriptions of patients who died in hospital over a seven-week period in 2020 with a primary diagnosis of C-19, known to the hospital specialist palliative care team (HSPCT) were analysed and compared with data from patients with PLD in a similar period in 2019, known to the same HSPCT. Results: 34 patients with C-19 compared with 26 PLD patients (88.5% respiratory malignancy, 7.7% COPD and 3.8% bronchiectasis). Mean age 76 years vs 71. Average time from admission to referral f 8 vs 6 days, time to death average of 2.7 vs 7 days from point of referral . Both groups experienced an average 2.4 symptoms with most common being dyspnoea (76.5% vs 69.2%), pain (73.5% vs 65.4%), agitation (38.2% vs 42.3%) and respiratory secretions (38.2% vs 38.5%). Medications in 24 hours prior to death for C-19 group morphine equivalent daily dose (MEDD) average 20.4mg versus 62.4mg, midazolam 8.8mg vs 5.8mg, levomepromazine 12.5mg vs 6.25mg, hyoscine butylbromide 60mg vs 100mg. The MEDD in the C-019 group was higher, but increase since admission was 10mg in both groups. Conclusions: Similar symptoms experienced in both groups with possibly more complex symptom control in PLD. C-19 patients had greater requirement for anti-agitation medication while PLD patients had greater opioid requirements. Higher opioid dose in PLD patients secondary to long term symptom control, however average opioid requirements increment by same amount. Doses in C-19 were within the range of established guidelines.