Author: Jeanette G. Ferrer, DO
Dyspnea is a subjective sensation of difficulty breathing.
Dyspnea is one of the most common symptoms encountered at the end of life.
The causes are multi-dimensional including:
- lung or heart conditions,
- anemia, anxiety,
- chest wall pathology,
- electrolyte disturbances,
- urinary retention or
Anxiety, fear of impending death and pain contribute to the subjective symptoms of dyspnea.
Assess intensity via subjective report, visual analog scale, and physical examination. Other evaluation tools include pulse oximetry and if indicated Chest X-Ray.
Treatment of underlying causes as indicated:
- Pleural effusion: drainage if the effusion is significant
- Anemia: transfusion of packed red blood cells
- Airway obstruction by tumor: corticosteroids (e.g., dexamethasone), radiation therapy
- Carcinomatous lymphangitis: corticosteroids (e.g., dexamethasone)
- Underlying COPD: optimize use of bronchodilators, addition of steroids
- Pulmonary embolism: anticoagulant
- Pneumonia: antibiotics (oral route preferred).
Symptomatic measures may include the following:
- Supplemental oxygen can be helpful for symptom control. Most patients prefer nasal prongs instead of facial masks.
- Opioids: Systemic opioids reduce the subjective sensation of dyspnea without reducing respiratory rate or O2 saturation.
- Diuretics: Patients with congestive heart failure or noncardiogenic pulmonary edema may benefit from furosemide 10 - 20 mg IV/SC.
- Benzodiazepines: Have not been found in randomized controlled trials to be effective in the management of dyspnea. They can be effective in patients with specific indications, such as major anxiety episodes.
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