An Approach to Dyspnea in Advanced Disease

Overview

Journal Can Fam Physician

Specialties General Medicine
Public Health

Date 2004 Jan 8

PMID 14708926

Citations 1

Authors

Romayne Gallagher

Affiliations

Soon will be listed here.

Abstract

Introduction: To describe an approach to assessment and treatment of dyspnea.

Sources Of Information: New level I evidence can guide management of dyspnea in advanced illness. Assessment and use of adjuvant medications and oxygen relies on level II and III evidence.

Main Message: Opioids are first-line therapy for managing dyspnea in advanced illness. They are safe and effective in reducing shortness of breath. Neuroleptics are useful adjuvant medications. Evidence does not support use of oxygen for every patient experiencing dyspnea; it should be tried for patients who do not benefit from first-line medications and nonmedicinal therapies.

Conclusion: Opioids relieve dyspnea and are indicated as first-line treatment for dyspnea arising from advanced disease of any cause.

Citing Articles

Opioid-induced neurotoxicity.

Gallagher R Can Fam Physician. 2007; 53(3):426-7.

PMID: 17872676 PMC: 1949075.

References

Pan C, Morrison R, Ness J, Leipzig R . Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage. 2000; 20(5):374-87. DOI: 10.1016/s0885-3924(00)00190-1. View

Chochinov H, Tataryn D, Clinch J, Dudgeon D . Will to live in the terminally ill. Lancet. 1999; 354(9181):816-9. DOI: 10.1016/S0140-6736(99)80011-7. View

JENNINGS A, Davies A, Higgins J, Broadley K . Opioids for the palliation of breathlessness in terminal illness. Cochrane Database Syst Rev. 2001; (4):CD002066. DOI: 10.1002/14651858.CD002066. View

Tanaka K, Akechi T, Okuyama T, Nishiwaki Y, Uchitomi Y . Factors correlated with dyspnea in advanced lung cancer patients: organic causes and what else?. J Pain Symptom Manage. 2002; 23(6):490-500. DOI: 10.1016/s0885-3924(02)00400-1. View

Abernethy A, Currow D, Frith P, Fazekas B, McHugh A, Bui C . Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ. 2003; 327(7414):523-8. PMC: 192892. DOI: 10.1136/bmj.327.7414.523. View

Jennett S, Barker J, Forrest J . A double-blind controlled study of the effects on respiration of pentazocine, phenoperidine and morphine in normal man. Br J Anaesth. 1968; 40(11):864-75. DOI: 10.1093/bja/40.11.864. View

Woodcock A, Gross E, Geddes D . Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers. Br Med J (Clin Res Ed). 1981; 283(6287):343-6. PMC: 1506180. DOI: 10.1136/bmj.283.6287.343. View

Arunasalam K, Davenport H, Painter S, Jones J . Ventilatory response to morphine in young and old subjects. Anaesthesia. 1983; 38(6):529-33. View

ONeill P, Morton P, Stark R . Chlorpromazine--a specific effect on breathlessness?. Br J Clin Pharmacol. 1985; 19(6):793-7. PMC: 1463882. DOI: 10.1111/j.1365-2125.1985.tb02716.x. View

10.

Man G, Hsu K, Sproule B . Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest. 1986; 90(6):832-6. DOI: 10.1378/chest.90.6.832. View

11.

Schwartzstein R, LaHive K, Pope A, Weinberger S, Weiss J . Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis. 1987; 136(1):58-61. DOI: 10.1164/ajrccm/136.1.58. View

12.

Young I, Daviskas E, Keena V . Effect of low dose nebulised morphine on exercise endurance in patients with chronic lung disease. Thorax. 1989; 44(5):387-90. PMC: 461838. DOI: 10.1136/thx.44.5.387. View

13.

Munck L, Christensen C, Pedersen L, Larsen U, Branebjerg P, Kampmann J . Codeine in analgesic doses does not depress respiration in patients with severe chronic obstructive lung disease. Pharmacol Toxicol. 1990; 66(5):335-40. DOI: 10.1111/j.1600-0773.1990.tb00759.x. View

14.

Swinburn C, Mould H, Stone T, Corris P, Gibson G . Symptomatic benefit of supplemental oxygen in hypoxemic patients with chronic lung disease. Am Rev Respir Dis. 1991; 143(5 Pt 1):913-5. DOI: 10.1164/ajrccm/143.5_Pt_1.913. View

15.

Bruera E, de Stoutz N, Schoeller T, Hanson J . Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet. 1993; 342(8862):13-4. DOI: 10.1016/0140-6736(93)91880-u. View

16.

Bruera E, MacEachern T, Ripamonti C, Hanson J . Subcutaneous morphine for dyspnea in cancer patients. Ann Intern Med. 1993; 119(9):906-7. DOI: 10.7326/0003-4819-119-9-199311010-00007. View

17.

Burdon J, PAIN M, Rubinfeld A, Nana A . Chronic lung diseases and the perception of breathlessness: a clinical perspective. Eur Respir J. 1994; 7(7):1342-9. DOI: 10.1183/09031936.94.07071342. View

18.

Booth S, Kelly M, Cox N, Adams L, Guz A . Does oxygen help dyspnea in patients with cancer?. Am J Respir Crit Care Med. 1996; 153(5):1515-8. DOI: 10.1164/ajrccm.153.5.8630595. View

19.

AIDA A, Miyamoto K, Nishimura M, Aiba M, Kira S, Kawakami Y . Prognostic value of hypercapnia in patients with chronic respiratory failure during long-term oxygen therapy. Am J Respir Crit Care Med. 1998; 158(1):188-93. DOI: 10.1164/ajrccm.158.1.9703092. View

20.

Dudgeon D, Lertzman M . Dyspnea in the advanced cancer patient. J Pain Symptom Manage. 1998; 16(4):212-9. DOI: 10.1016/s0885-3924(98)00065-7. View