Contents
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.
Management 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