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This assignment will look at non pharmacological interventions available for End of Life Care (EOLC) for patients with Chronic Obstructive Pulmonary Disease (COPD). It will discuss some of  the different options that are freely accessible to improve some of the symptoms common to COPD patients during the end stages of there disease. It will also look at Advanced Care Planning (ACP) and how this should enable health care professionals get a better understanding what is important to patients their families and those close to them at End Of Life. Advanced Care Planning aims to improve patients understanding of some of the choices that they may have to face in the future. It is a process to help plan for future medical care with regard to certain treatment options and record these wishes for patients. It also seeks to support patients to work through any issues and then both make decisions and convey these decisions to people that are important in their lives and to appropriate health professionalsChronic illness continues to raise a major public health challenge in our current health care system. The majority of patients with chronic health issues spend the last months of life in and out of the hospital settings with approximately half of those dying in the acute health care setting.  During the last days of life, quality palliative health care is essential as it can help reduce physical, psychological and spiritual distress. This form of care aims at providing health care with the main aim of meeting the health needs of the individuals whose life expectancy is reduced as a result of a life limiting condition and also where the primary role of care is shifted from prolonging the life to the provision of quality life .Quality of EOLC primary aims at assessing the progression of life limiting illness all through the physical impairment to the psychological impacts it has on the family members . It is important to know that palliative care does not hasten death but rather incorporate the different treatment options that aims at prolonging life through quality improvement. Provision of high quality EOLC provides for the physical, psychological and spiritual need of both the patient and the care givers. This is ensured by involving the patients in decision making pertaining their health through respecting their choice and autonomy as well as team work through the collaboration to the multidisciplinary team in the provision of care. As such the main principle during the end of life includes provisions where the patients are involved in decisions pertaining to their own care.There are many different palliative care guidelines that govern that process of caring for patients with life limiting conditions. The Department of Health provide us with National Institute for Health and Care Excellence (NICE) guidelines on care of the dying adult. They advocate for high quality care for the patients arguing that when delivered to the patient, EOLC should at least contribute to improving of the safety, and effectiveness of the care for adults in their last days  . These guidelines state that care for such adults should be done in the following ways;• Making sure that patients get a positive experience of care• Improving the overall quality of life for patients with long term conditions• Treating patients in a safe environment and keeping them away from healthcare related harm.The NICE guidelines act in unison with wide range of policies such as the End of Life Care policy and National Council for Palliative Care. Together, these policies and guidelines ensure that patients are given high quality care .           The majority of patients who have chronic illness go through a different disease trajectory to patient who have a cancer diagnosis therefor it is more difficult to predict when patients are entering the dying phase of their illness. As a result, there is the need for the healthcare system to provide personalised and holistic care for End Of Life patients. According to the World Health Organisation “Palliative care aims at improving the quality of life for patients and their families”. They are associated with life threatening illness through the prevention, relief of suffering and treatment of pain and other physical, psychological and spiritual problems. .In the past, palliative care was mainly for cancer patients; however, due to age advancements there has been an increase in the incidence of major chronic illness and therefore more patients requiring palliative care. Over the recent past it has been emergence of these groups of patients requiring palliative care that has fuelled the need for increased quality and effectiveness of palliative health care services. Quality care provision has been a priority in the health care system over the past few decades. While there has been a drastic increase in the cases of chronic illness in the society, there is the need for medical advancements to help in controlling the incidences . Provision of EOLC should optimises the quality of care among patient with incurable diseases. It is, therefore, the role of all healthcare professionals to provide quality and compassionate care from the time the diagnosis of the terminal illness is made, to the time of death.  Collaborative care, regular reassessment and communication between patients, their families and those important to them as well other health care professionals is essential to providing a high standard of palliative care.         Chronic Obstructive Pulmonary Disease represents a significant public health challenge leading to chronic morbidity and significant mortality throughout the world. It is the fourth leading cause of death in the world and projected to be the third by 2020. In 2012, it was estimated that 6% of the total mortality was a result of COPD. For the majority of patients with COPD, they experience the better part of their life marked with progressive dyspnea, reduced functionality as well as social isolation . Owing to the increased prevalence of COPD in the society, it has a significant individual, social and economic burden as it is very expensive to manage. This burden is expected to grow further due to the continued exposure to the risk as well as the ageing population.Some of the factors associated with the development of COPD include smoking/ passive smoking, environmental pollutants, work related exposure and Genetic factors. The symptoms of the disease include a cough, slow and progressive dyspnea with the symptoms being insidious and nonspecific. As a result, there is a late diagnosis of the disease which limits the interventions and treatment options.Quality care provision has been a priority in the health care system over the past few decades. While there has been a drastic increase in the cases of chronic illness in the society, there is the need for medical advancements to help in controlling the incidences. Provision of EOLC aims at optimising the quality of care among patients with incurable diseases. The principles of care for a patient with a terminal illness are similar to those with palliative diagnosis. It is, therefore, the role of all healthcare professionals to provide quality and compassionate care from the time the diagnosis of the terminal illness is made, to the time of death.It has been found that non pharmacological interventions can often relieve and sometime hold off some of the symptoms of COPD and have been found to be of great benefit to patients and there carers during the palliative stage of their illness. Breathlessness and Fatigue clinics Almost all patients with COPD experience fatigue and breathlessness, therefore the need for a program to help them cope with these symptoms are essential. Breathlessness is the feeling of being out of breath especially for patients with chronic respiratory illness. In most cases, the feeling is experienced with less exertion than what is expected. The primary role of the clinics is to provide support to the patients as well as their families. The breathlessness clinics are designed to help patients be in a position to be able to carry on with their daily activities in their own homes . These clinics often have a rolling programme, some lasting six to eight weeks. These programs often involve the wider multidisciplinary teams and include nutrition support, help with activities of daily living and complimentary therapies.  The breathlessness and fatigue clinics are different from the rehabilitation programs since they are tailored to individuals focusing more on increasing the confidence and the strategies to help patients with breathlessness and fatigue. Smoking Cessation Smoking Cessation has been used over the years for management of patients with COPD who have a decline in their lung function. Research shows that, among these patients, there is a reduction in the rate at which the lungs are destroyed, and as a result, there is an increase in the quality of life. Hypnotherapy and Acupuncture  have not been found to be very successful in smoking cessation but may be suitable for some patients.Pulmonary RehabilitationAmong patients with COPD, pulmonary rehabilitation is designed to optimise physical and social functioning. It is a multidisciplinary and comprehensive intervention for patients who have reduced quality of life and those who are symptomatic . Main activities in this program include exercise training, behavioural and psychosocial interventions and nutritional therapy. The physical exercise program provides strength and endurance training individualised with the primary aim of increasing the capacity and the strength of the patients . The rehabilitation program is often aimed at breaking the vicious cycle of COPD and therefore improving the exercise capability as well as the conditioning of the affected patients.Pulmonary rehabilitation has for long been associated with several benefits such as improvement of exercise tolerance, reduction in dyspnea, improvement of the quality of life, decrease in social isolation, anxiety and depression . Exercise training is considered as the cornerstone of pulmonary rehabilitation. As such, research shows that among patients who are involved in pulmonary rehabilitation programs, there is the increased probability of the reduction in the exacerbations as well as the number of hospitalisation among these patients .Breathing exercisesAmong patients with COPD, a variety of breathing exercises are employed. The main aim of the practices is to reduce the case of dyspnea through alteration of the respiratory muscle recruitment, reduction in the lung hyperventilation, improvement of the respiratory muscle functioning as well as the optimisation of the thoraces-abdominal motion.Chest physiotherapy (Airway Clearance Techniques)Patients who have COPD more often than not present with chronic bronchitis, co-existence bronchiectasis and others exacerbation of COPD symptoms. The use of Airway Clearance Techniques enables the patients to clear the sputum with the aim of reducing paroxysmal coughing , reduce the lung function decline as well as reduce the frequency of exacerbations, therefore enhancing recovery from the cases of exacerbations . Different techniques are employed for airway clearance. They include the active cycle breathing techniques, the positive expiratory pressure therapy and the autogenic drainage. In autogenic treatment, the principle applied in this form of therapy aims at achieving the highest possible airflow for the different bronchioles . It is crucial for patients who are positive for chronic sputum reduction to be referred to a physiotherapist for the purpose of assessment and education regarding the best appropriate form of actions based on the manifestations of the patient.Non-invasive positive pressure ventilation (NIPPV)Patients with COPD have associated hypercapnia and increased respiratory acidosis. Therefore, implementation of the NIPPV helps in the reduction of the acidosis and hypercapnia. In this form of modality, the NIPPV is delivered via a face mask or nasal cannula with the aim of achieving hyperventilation and providing respiratory muscle rest among patient with COPD . In the past, the NIPPV was used for managing patients with severe exacerbations of COPD, however, in the recent past; the therapy has been seen to be beneficial among patients with associated comorbidities such as sleep apnea or obesity hypoventilation syndrome.Advance Care Planning Provision of the EOLC among patients with advanced, progressive and incurable diseases enables the patients to live in comfortably until they die. Further, both the palliative and support needs are identified and met throughout from the time the diagnosis is made and into bereavement. Management of pain includes all aviation of symptoms as well as the provision of psychological, social and spiritual support . Patients and family members are involved throughout and handled with respect and compassionate so as to produce the best possible outcomes.Palliative and EOLC are essential to the improvement of the quality of care among the terminally ill patients. In spite of this, there exist unclear circumstances on some of the ways that seem best in the development of the quality of care. Research shows that, despite the different studies, there has been no significant improvement in the provision of care. As a result, there is the need for further research to determine some of the advancements that should be arrived out for the improvement of care among patients who have terminal illness such as COPD. Research shows that, for patients with COPD, the end of life care provided is often worse than those with other chronic diseases such as lung cancer. Variations in the care provided are due to the patient’s attitudes and preferences, changes in disease trajectories as well as the difference in the healthcare provider’s preferences and opinions. Chronic Obstructive Disease is symptomatic with patients presenting with elements of fatigue, dyspnea, insomnia and depression and majorly requires symptom-based palliative treatment. In this context palliative approaches are essential for the end of life are as well as hospice care.Advance Care Planning is an essential component in the provision of end of life care among patients with COPD. Research results provide evidence of the associated benefits of ACP. Among patients with COPD, there is increased patient satisfaction, improvement in the sense of control, as well as improvement in the psychosocial life through the reduction of the fear, anxiety and emotional distress . Majority of those with COPD, in the past, have preferred to undertake this due to its associated benefits. Despite the desire for the majority of the patients with COPD to be involved in advance care planning, few undergo through the process. Some of the challenges that have hindered the efficient advance care planning delivery include the perception of the patients on the quality of communication . Previous research shows that, in the majority of the cases, patients have often rated their physicians poorly in terms of the discussion of the prognosis, spirituality as well as the process of dying.Provision of care for patients with advanced COPD remains a challenge for majority of the healthcare professionals. Over the years, number of people suffering from COPD continues to rise drastically as compared to other chronic illness . As a result, there is need for advanced care for patients with chronic obstructive pulmonary disease. As aforementioned, advance care planning is a process of communication where patients are informed of their diagnosis, prognosis, and treatment options. ACP is regarded as an effective approach to dealing with patients with COPD because, unlike other methods, it allows them to give their goals and preferences for life sustaining treatments throughout the course of the disease . It also enables them to engage in conversations about hopes and fears making them surrogate medical decision makers. In addition to Advance Care Planning (ACP), to overcome challenges associated with dealing with patient suffering from COPD, there is need to integrate spiritual care for the patients. Researchers indicate that integration of spiritual practices in the care for COPD patient enables the patient to not only relieve stress and have a sense of control and hope but also a feeling of greater purpose. In fact, researchers find that where spiritual care is used, patients with COPD tend to cope well with the remaining days of their life.ConclusionChronic Obstructive Pulmonary Disease is among the leading causes of respiratory death in the world. Provision of End of Life Care among patients with chronic illness can help in the reduction of the psychological distress experienced not only by the patients but also the caregivers. EOLC aims at incorporating the different treatment modalities with the aim of prolonging the life through quality improvement. The care provided is determined by providing holistic care through the integration of the physical, psychological and the spiritual needs of both the patients and the caregivers. Concurrently, achievement of the best possible outcomes should ensure there is the incorporation of the patients during the decision making process. More importantly, all healthcare providers including the nurses, doctors, specialist and the physiotherapists should work in collaboration with one another.Management of patients with COPD entails the pharmacological and the nonpharmacological therapies. Research indicates that the use of nonpharmacological treatments helps in yielding better symptomatic improvement and therefore an increase in the quality f life for the affected patients. Since the symptoms of COPD are progressive and insidious, the diagnosis is often made late, and this limits the interventions and the treatment options for the patients.Breathlessness and fatigue clinics have been put in place with the aim of reducing the symptoms of those patients with COPD. They are run in collaboration with palliative specialists, physiotherapists, and nurses. Smoking cessation has for long been utilised for the management of patients with COPD due to the associated decline in the deterioration of lung function. Other interventions that have been put in place in the current healthcare sector include the pulmonary rehabilitation, chest physiotherapy, and noninvasive positive pressure ventilation. Advance care planning is an essential competent to end of life care. As such, patients and their families are communicated to the expected outcomes and thereafter decisions are made depending on their desire. As such, there is the incorporation of the psychological and the spiritual care of the respective individuals. Therefore, there is the need for integration of care that takes care of both the physical and the mental wellbeing of the patient.