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Breathlessness

(Dyspnoea)

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Dyspnoea / Breathlessness

is an uncomfortable sensation or awareness of

breathing

It is one of the most frightening and distressing

symptoms for patients with cancer

Occurs in a third of all patients for Palliative

Care

[Potter et al 2003]

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Breathlessness

(dyspnea) . . .Described as

shortness of breatha smothering feeling

inability to get enough air

suffocation

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. . . Breathlessness

(dyspnea)Only reliable measure is patient self-

reportRespiratory rate, pO2, blood gas

determinations DO NOT correlate

with the feeling of breathlessness

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Causes of

breathlessness Anemia

Anxiety

Airway obstruction

ronchospasm

!ypoxemia "nfections

#etabolic

$leural effusion

$ulmonary edema

$ulmonary

embolism

Thic% secretions

&amily ' financial '

legal ' spiritual '

practical issues

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Management

of breathlessness . . .Treat the underlying cause

antibioticsa(oid fluid o(erload

dry secretions

#echanical (entilation

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. . . Management

of breathlessness)ymptomatic management

oxygenopioids

anxiolytics

nonpharmacologic inter(entions

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Oxygen

$ulse oximetry not helpful

$otent symbol of medical care*xpensi(e

&an may do +ust as well

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Opioids

)mall doses

entral and peripheral actionRelief not related to respiratory rate

No ethical or professional barriers

Do not shorten life

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Anxiolytics

)afe in combination with opioids

loraepam ./0-2 mg po 1 h prn until settled

then dose routinely 1 345 h to %eep settled

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onpharmacologic

inter!entions . . .Reassure, wor% to manage anxiety

eha(ioral approaches, eg,relaxation, distraction, hypnosis

6imit the number of people in the

roomOpen window

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onpharmacologic

inter!entions . . .*liminate en(ironmental irritants

7eep line of sight clear to outsideReduce the room temperature

A(oid chilling the patient

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. . .

onpharmacologicinter!entions "ntroduce humidity

Repositionele(ate the head of the bed

mo(e patient to one side or other

*ducate, support the family

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