There Is Urgent Need to Integrate Respiratory and Palliative Care: Natasha Smallwood, BMedSci, MBBS, MSc

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Patients with serious, nonmalignant respiratory illnesses experience profound and prolonged symptoms that significantly reduce their quality of life, explained Natasha Smallwood, BMedSci, MBBS, MSc, on day 1 of the European Respiratory Society Congress 2025. “Someone with COPD, might live with, on average, 11 symptoms for a few years, which is actually far worse than living with lung cancer,” she said. Despite such significant unmet needs, care has traditionally focused on managing the underlying illness rather than alleviating symptoms, says Smallwood, who is professor of respiratory medicine at Monash University and professor and director of respiratory medicine at the Alfred Hospital in Melbourne, Australia.

She presented, “What are the challenges and benefits of providing integrated respiratory and palliative care in urban and rural settings?” in a session that examined primary and integrated respiratory care through the lens of achieving universal coverage for lung health.

These patients, she notes, often endure social isolation and a diminished quality of life, with referrals to specialist palliative care services frequently occurring only in the last 24 hours of life—a delay in care that represents a missed opportunity to provide comprehensive care during the most symptomatic years of their illness. To address this gap, integrated respiratory and palliative care models have emerged over the last 15 to 20 years that combine the services earlier in the course of an illness. The core concept involves collaboration between respiratory clinicians, general practitioners, and palliative care specialists to deliver a different, more holistic type of care.

Two main types of effective models have been developed. Short-term, symptom-focused models, such as the Cambridge Breathlessness Intervention Service in the UK, concentrate on managing challenging symptoms, like breathlessness, to improve quality of life. In this model, a patient might see a respiratory specialist, respiratory nurse, and palliative care specialist a few times to develop a symptom management plan. In contrast, long-term models provide continuous care, often until death. An example is the integrated service that Smallwood established at the Royal Melbourne Hospital in 2012, which offered multiprofessional and multidisciplinary care from nurses, allied health staff, and specialists in both respiratory and palliative medicine. This model also focused on early identification of patients, such as those with frequent emergency department visits, to offer integrated support sooner.

Evidence shows that both short- and long-term models are effective. The key to successful implementation is flexibility and adaptation to the local context, being able to develop a new service that requires considering available resources, the needs of urban vs rural settings, and, most critically, the preferences of patients and their caregivers.