Shortness of Breath in Palliative Care
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  • 8 Feb, 2020
  • Post author:Dr Tom Leach
  • Reading time:2 mins read
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Shortness of breath / dyspnoea = a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity

Assessment of shortness of breath

  • Onset e.g. sudden/gradual
  • Timing e.g. constant/intermittent
  • Exacerbating/relieving factors e.g. when lying flat or walking
  • Associated features e.g cough or chest pain
  • Severity i.e. impact on day to day life
  • Underlying diagnosis e.g. lung cancer

Causes of shortness of breath in palliative care:

  • Effect of cancer e.g. lung cancer
  • Pulmonary effusion e.g. malignant effusion
  • Restriction e.g. superior vena cava obstruction or ascites
  • Pulmonary embolus (High risk due to underlying malignancy and associated immobility)
  • Anaemia
  • Pneumonia
  • Pain
  • Anxiety

It is also important to remember that any cause of shortness of breath in a non-palliative patient can also occur here.

Manag​ement of shortness of breath in palliative care

  • Treat underlying cause e.g. drain an effusion
  • Lifestyle changes
  • Symptomatic treatment- pharmacological and non-pharmacological
  • Rehabilitation

Phamacological treatment

Nebulisers- bronchodilators e.g. salbutamol if reversible airways obstruction or sailine to aid expectoration
Opioids e.g. oramorph 2.5mg PRN 4hourly
Benzodiazepines esp in anxiety e.g. lorazepam
If á secretions- glycopyrronium or hyosceine hydrobromide (dry up secretions)

Non-pharmacological treatment

  • Explanation and reassurance
  • Oxygen
  • Physiotherapy and positioning e.g. sitting down and leaning forward
  • Coping mechanisms e.g. minimising activity
  • Fans
  • Psychotherapy for anxiety
  • Alternative therapies and relaxation techniques

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) FRACGP currently works as a GP and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University, and is studying for a Masters of Sports Medicine at the University of Queensland. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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