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Dyspnea review for the palliative care professional: Treatment goals and therapeutic options

Journal Article


Abstract


  • Although dyspnea is frequently encountered in the palliative care setting, its optimal management remains uncertain. Clinical approaches begin with accurate assessment, as delineated in part one of this two-part series. Comprehensive dyspnea assessment, which encompasses the physical, emotional, social, and spiritual aspects of this complex symptom, guide the clinician in choosing therapeutic approaches herein presented as part two. Global management of dyspnea is appropriate both as complementary to disease-targeted treatments that target the underlying etiology, and as the sole focus when the symptom has become intractable, disease is maximally treated, and goals of care shift to comfort and quality of life. In this setting, current evidence supports the use of oral or parenteral opioids as the mainstay of dyspnea management, and of inhaled furosemide and anxiolytics as adjuncts. Nonpharmacologic interventions such as acupuncture and pulmonary rehabilitation have potential effectiveness, although further research is needed, and use of a simple fan warrants consideration given its potential benefit and minimal burden and cost. �� 2012, Mary Ann Liebert, Inc.

Publication Date


  • 2012

Citation


  • Kamal, A. H., Maguire, J. M., Wheeler, J. L., Currow, D. C., & Abernethy, A. P. (2012). Dyspnea review for the palliative care professional: Treatment goals and therapeutic options. Journal of Palliative Medicine, 15(1), 106-114. doi:10.1089/jpm.2011.0110

Scopus Eid


  • 2-s2.0-84856354282

Start Page


  • 106

End Page


  • 114

Volume


  • 15

Issue


  • 1

Place Of Publication


Abstract


  • Although dyspnea is frequently encountered in the palliative care setting, its optimal management remains uncertain. Clinical approaches begin with accurate assessment, as delineated in part one of this two-part series. Comprehensive dyspnea assessment, which encompasses the physical, emotional, social, and spiritual aspects of this complex symptom, guide the clinician in choosing therapeutic approaches herein presented as part two. Global management of dyspnea is appropriate both as complementary to disease-targeted treatments that target the underlying etiology, and as the sole focus when the symptom has become intractable, disease is maximally treated, and goals of care shift to comfort and quality of life. In this setting, current evidence supports the use of oral or parenteral opioids as the mainstay of dyspnea management, and of inhaled furosemide and anxiolytics as adjuncts. Nonpharmacologic interventions such as acupuncture and pulmonary rehabilitation have potential effectiveness, although further research is needed, and use of a simple fan warrants consideration given its potential benefit and minimal burden and cost. �� 2012, Mary Ann Liebert, Inc.

Publication Date


  • 2012

Citation


  • Kamal, A. H., Maguire, J. M., Wheeler, J. L., Currow, D. C., & Abernethy, A. P. (2012). Dyspnea review for the palliative care professional: Treatment goals and therapeutic options. Journal of Palliative Medicine, 15(1), 106-114. doi:10.1089/jpm.2011.0110

Scopus Eid


  • 2-s2.0-84856354282

Start Page


  • 106

End Page


  • 114

Volume


  • 15

Issue


  • 1

Place Of Publication