Skip to main content
placeholder image

Chronic refractory dyspnoea: Evidence based management

Journal Article


Abstract


  • Background: Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases. Objective: To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe, symptomatic management of chronic refractory dyspnoea. Discussion: Dyspnoea is mostly multifactorial. Each reversible cause should be managed (Level 4 evidence). Non-pharmacological interventions include walking aids, breathing training and, in chronic obstructive pulmonary disease, pulmonary rehabilitation (Level 1 evidence). Regular, low dose, sustained release oral morphine (Level 1 evidence) titrated to effect (with regular aperients) is effective and safe. Oxygen therapy for patients who are not hypoxaemic is no more effective than medical air. If a therapeutic trial is indicated, any symptomatic benefit is likely within the first 72 hours.

Publication Date


  • 2013

Citation


  • Wiseman, R., Rowett, D., Allcroft, P., Abernethy, A., & Currow, D. (2013). Chronic refractory dyspnoea: Evidence based management. Australian Family Physician, 42(3), 137-140.

Scopus Eid


  • 2-s2.0-84875515140

Start Page


  • 137

End Page


  • 140

Volume


  • 42

Issue


  • 3

Place Of Publication


Abstract


  • Background: Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases. Objective: To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe, symptomatic management of chronic refractory dyspnoea. Discussion: Dyspnoea is mostly multifactorial. Each reversible cause should be managed (Level 4 evidence). Non-pharmacological interventions include walking aids, breathing training and, in chronic obstructive pulmonary disease, pulmonary rehabilitation (Level 1 evidence). Regular, low dose, sustained release oral morphine (Level 1 evidence) titrated to effect (with regular aperients) is effective and safe. Oxygen therapy for patients who are not hypoxaemic is no more effective than medical air. If a therapeutic trial is indicated, any symptomatic benefit is likely within the first 72 hours.

Publication Date


  • 2013

Citation


  • Wiseman, R., Rowett, D., Allcroft, P., Abernethy, A., & Currow, D. (2013). Chronic refractory dyspnoea: Evidence based management. Australian Family Physician, 42(3), 137-140.

Scopus Eid


  • 2-s2.0-84875515140

Start Page


  • 137

End Page


  • 140

Volume


  • 42

Issue


  • 3

Place Of Publication