Pulmonary disease is classified as any abnormal condition of the respiratory system, characterized by cough, chest pain, dyspnea, hemoptysis, sputum production, stridor, or adventitious sounds. Diagnostic procedures for pulmonary diseases include bronchoscopy; cytologic, serologic, and biochemical examination of bronchial secretions; laryngoscopy; pulmonary function tests; and radiography.

Patients will be considered to be in the terminal stage of pulmonary disease if they meet the following criteria: 1 and 2 MUST be present; factors 3, 4 and/or 5 provide supporting documentation.

1. Severe chronic lung disease as documented by BOTH A and B:

A. Disabling dyspnea at rest, poorly or unresponsive to bronchodilators, resulting in decreased functional capacity, e.g., bed to chair existence, fatigue, and cough (documentation of Forced Expiratory Volume in one second (FEV1), after bronchodilator, less than 30% of predicted is objective evidence for severe chronic lung disease, but is not necessary to obtain).

B. Progression of end stage pulmonary disease, as evidenced by increasing visits to the emergency department or hospitalizations for pulmonary infections and/or respiratory failure (documentation of serial decrease in FEV1 of greater than 40 ml/year is objective evidence for disease progression, but is not necessary to obtain).

2. Hypoxemia, as evidenced by:

  • Oxygen saturation of 88% or less on room air.
  • O2 <= 55 mm Hg

(These values may be obtained from recent hospital records)

  • OR persistent hypercapnia, as evidenced by pCO2 ≥50 mmHg. 

(This value may be obtained from hospital records within preceding three months)

Documentation of the following factors may provide additional support for end stage pulmonary disease.

3. Corpulmonale or right heart failure (RHF) secondary to pulmonary disease (e.g., not secondary to left heart disease or valvulopathy).

4. Unintentional progressive weight loss of greater than 10% of body weight over the preceding six months.

5. Resting tachycardia >100/min.

If a patient meets the medical criteria above, they are by definition eligible for hospice services. Some patients may not meet the criteria, but still be eligible for hospice due to comorbidities or rapid functional decline.