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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">What do Obstructive pulmonary disease&#44; interstitial lung disease&#44; neuromuscular disease&#44; Lung cancer&#44; Asthma&#44; Obstructive sleep apnea and Obesity hypoventilation syndrome have in common&#63; They all affect the respiratory system&#46; They are chronic and progressive conditions and they are&#44; for the most part&#44; incurable&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Advances in Medicine in recent decades have led to increased life expectancy&#44; including for patients with respiratory conditions&#46; Unfortunately&#44; curative treatment isn&#8217;t always possible and it may not mean that there is any increase in quality of life&#46; Diagnostic and therapeutic decisions may not be in line with the patients&#8217; real needs&#44; and may inflict greater suffering&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a> Patients with incurable disease are frequently highly symptomatic and suffer loss of functional ability&#44; which should justify a shift in our goals of care&#44; regardless of prognosis&#44; focusing on comfort&#44; dignity and quality of life&#46; This supports the rising importance of Palliative care&#44; a specialized field of Medicine&#44; with tools that could and should be learned by all doctors&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Particularly in Respiratory care&#44; there is&#44; without a doubt a call for greater education&#44; which should begin with basic training in Palliative care&#44; because so many respiratory conditions are&#44; as previously stated&#44; chronic and incurable&#46;<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a> The initial training process should begin during Respiratory specialty training&#44; which we feel currently has a gap in knowledge to be filled&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Palliative care interventions in respiratory conditions include management of symptoms such as dyspnoea&#44; fatigue&#44; cough&#44; haemoptysis and increased respiratory secretions&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Management of dyspnea has been object of particular interest in the past few years&#46; Pharmacological and non pharmacological therapies are available to relieve dyspnoea&#44; however there is still a general fear of implementing some of these measures&#44; mainly due to lack of knowledge of their benefits and risks&#44;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> particularly regarding opioid use&#46; Opioids remain first line recommendation with grade 1 level of evidence for the relief of respiratory distress in advanced lung diseases if other measures such as bronchodilators&#44; diuretics&#44; corticosteroids and other soothing measures are insufficient&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Education in Palliative care would add value to the current respiratory training programme&#44; both professionally and personally&#46; Communication skills are honed&#44; the patient is assessed globally&#44; interpreting signs and symptoms beyond the respiratory system&#44; with the aim of treating symptoms properly&#46; There is a focus on multi disciplinary team work and special care taken to avoid futile measures&#46; Medical care becomes more patient-centered with a focus on patient preference and views&#46; The family&#180;s role is paramount and their presence&#44; role and views taken into account during this approach which aims to validate the person as a whole&#59; their relationships and what matters to them becomes just as central as the disease which afflicts them&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Palliative patients often present with considerable complexity&#44; not only because of the presence of multiple co morbidities and the severity of their main disease&#44; but also due to the many dimensions that influence patient suffering&#46; Frequently there is no readjustment in goals of care&#44; so that the main purpose becomes quality above quantity of life&#44; with the latter being something that should not be achieved at any cost&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> This readjustment of goals is still perceived by some as &#8220;giving up&#8221;&#44; which adds to the stigma attached to palliative care&#46; It should be seen as the exact opposite&#59; investment in whatever is most suitable for the patient and their family&#59; this is what is recommended by the World Health Organization &#40;WHO&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Palliative care is defined by the WHO as an approach that improves quality of life for patients and their families when facing issues relating to life-threatening illness&#44; through the prevention and relief of suffering by means of early identification and treatment of pain and other symptoms&#44; and also issues in the physical&#44; psychosocial spiritual fields&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">This definition is a tall order&#59; its major goal to act on global human suffering and provide comfort and dignity&#44; both to the patient and their family&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> After a placement in a Palliative care unit&#44; during their respiratory training programme the author argues that education in this field is paramount for appropriate care of patients with advanced lung disease&#46; Considering current international recommendations for doctors and their training&#44; our present reality with increased prevalence of chronic and advanced disease and the desire to improve the patient experience&#44;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a> we believe that an integrated placement in Palliative care should be part of the Respiratory specialty training&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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