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Management Of Dyspnea.

J. Thomas, C. V. von Gunten
Published 2003 · Medicine

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Patients with cancer frequently report dyspnea, the uncomfortable awareness of breathing. Lung involvement with cancer does not predict its occurrence. Patients describe it as one of the most frightening and distressing symptoms, and patient self-report is the only reliable measure. Measurements of respiratory rate, oxygen saturation, and arterial blood gases do not measure dyspnea. Opioids in modest doses have been demonstrated to give effective relief of dyspnea, whether or not identifiable reversible causes exist. Medical management of dyspnea can be directed at the underlying cause when the potential benefits outweigh the burdens of such treatment. In rare cases where symptomatic treatment is unable to control dyspnea to the patient's satisfaction, sedation is an effective, ethical option.
This paper references
10.1042/CS0610429
Methods to assess breathlessness in healthy subjects: a critical evaluation and application to analyse the acute effects of diazepam and promethazine on breathlessness induced by exercise or by exposure to raised levels of carbon dioxide.
R. D. Stark (1981)
10.1016/0034-5687(89)90017-0
'Air hunger' arising from increased PCO2 in mechanically ventilated quadriplegics.
R. Banzett (1989)
10.1177/014107688908200507
Measuring Symptoms in Terminal Cancer: Are Pain and Dyspnoea Controlled?
I. Higginson (1989)
10.1164/AJRCCM/151.3_PT_1.751
Effect of inspiratory flow rate on respiratory sensation and pattern of breathing.
H. Manning (1995)
10.1136/thx.48.4.339
Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group.
M. Muers (1993)
10.1042/CS0690007
The measurement of breathlessness induced in normal subjects: validity of two scaling techniques.
L. Adams (1985)
10.1136/bmj.327.7414.523
Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea
A. Abernethy (2003)
10.1016/0034-5687(92)90131-F
Reduced tidal volume increases 'air hunger' at fixed PCO2 in ventilated quadriplegics.
H. Manning (1992)
10.1097/00002820-199308000-00008
The experience of dyspnea in late-stage cancer. Patients' and nurses' perspectives.
D. K. Roberts (1993)
10.1136/thorax.57.11.939
A systematic review of the use of opioids in the management of dyspnoea
A. Jennings (2002)
10.1136/bmj.283.6287.343
Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers.
A. Woodcock (1981)
10.1152/JAPPL.1991.71.6.2183
Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea.
O. Taguchi (1991)
10.1016/S0885-3924(98)00157-2
How effective are supplementary doses of opioids for dyspnea in terminally ill cancer patients? A randomized continuous sequential clinical trial.
P. Allard (1999)
10.1016/S0885-3924(98)00149-3
The symptom burden of seriously ill hospitalized patients. SUPPORT Investigators. Study to Understand Prognoses and Preferences for Outcome and Risks of Treatment.
N. Desbiens (1999)
10.1016/S0024-3205(00)00434-3
Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea.
S. E. Zebraski (2000)
10.1073/PNAS.98.4.2029
Neuroimaging of cerebral activations and deactivations associated with hypercapnia and hunger for air.
S. Brannan (2001)
10.1016/S0140-6736(86)92732-7
CONTROLLED TRIAL OF ACUPUNCTURE FOR DISABLING BREATHLESSNESS
K. Jobst (1986)
10.1042/CS0740275
Ventilation and breathlessness on maximal exercise in patients with interstitial lung disease after local anaesthetic aerosol inhalation.
A. Winning (1988)
10.1007/PL00007721
Palliative therapy in the terminal stage of neurological disease
R. Voltz (1997)
10.1177/026921639400800315
Nebulized frusemide for dyspnoea
P. Stone (1994)
10.1001/ARCHINTE.163.3.341
Sedative use in the last week of life and the implications for end-of-life decision making.
N. Sykes (2003)
10.1152/JAPPL.1984.57.4.931
Perspectives in carotid body research.
C. Eyzaguirre (1984)
10.1093/BRAIN/122.9.1765
Haemodynamic brain responses to acute pain in humans: sensory and attentional networks.
R. Peyron (1999)
10.1378/CHEST.89.2.234
Dyspnea in terminally ill cancer patients.
D. Reuben (1986)
Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society.
P. Meek (1999)
10.1164/AJRCCM.162.3.2001001
Responses of tracheobronchial receptors to inhaled furosemide in anesthetized rats.
T. Sudo (2000)
10.1016/J.CRITREVONC.2004.04.004
Acute respiratory failure in the cancer patient: the role of non-invasive mechanical ventilation.
S. Nava (2004)
10.1016/S0885-3924(01)00367-0
Nebulized furosemide as a novel treatment for dyspnea in terminal cancer patients.
N. Shimoyama (2002)
10.1164/AJRCCM/142.5.1009
Distinguishable types of dyspnea in patients with shortness of breath.
P. M. Simon (1990)
10.1097/00001756-200007140-00012
Breathlessness in humans activates insular cortex
R. Banzett (2000)
10.1378/CHEST.103.3.800
Effects of buspirone on anxiety levels and exercise tolerance in patients with chronic airflow obstruction and mild anxiety.
N. P. Singh (1993)
10.1136/BMJ.318.7188.901
Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer.
M. Bredin (1999)
10.1191/026921600666097479
A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients
R. Fainsinger (2000)
10.1016/S0304-3959(97)00138-3
Pain processing during three levels of noxious stimulation produces differential patterns of central activity
S. Derbyshire (1997)
10.1136/HEART.89.9.1085
Safety and potential benefits of low dose diamorphine during exercise in patients with chronic heart failure
S. G. Williams (2003)
10.1042/CS0720693
Arterial oxygen saturation and breathlessness in patients with chronic obstructive airways disease.
R. Lane (1987)
10.1164/AJRCCM.159.5.ATS2-99
Pulmonary rehabilitation - 1999
S. Lareau (1999)
10.1164/AJRCCM/136.1.58
Cold facial stimulation reduces breathlessness induced in normal subjects.
R. Schwartzstein (1987)
10.1177/026921639400800106
Safety and efficacy of nebulized lignocaine in patients with cancer and breathlessness
A. Wilcock (1994)
10.1111/J.1365-2125.1985.TB02716.X
Chlorpromazine--a specific effect on breathlessness?
P. O'Neill (1985)
10.1016/S0885-3924(00)00190-1
Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review.
C. X. Pan (2000)
10.1136/THX.54.4.367
Ethical and clinical issues in the use of home non-invasive mechanical ventilation for the palliation of breathlessness in motor neurone disease
M. Polkey (1999)
10.1111/J.1523-5394.2000.86005.PP.X
Behavioral interventions for lung cancer-related breathlessness.
L. Gallo-Silver (2000)
10.1159/000196202
Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease.
P. Argyropoulou (1993)
10.1152/JN.2002.88.3.1500
BOLD fMRI identifies limbic, paralimbic, and cerebellar activation during air hunger.
K. Evans (2002)
10.7326/0003-4819-119-9-199311010-00007
Subcutaneous Morphine for Dyspnea in Cancer Patients
E. Bruera (1993)
10.1073/PNAS.96.5.2532
Correlation of regional cerebral blood flow and change of plasma sodium concentration during genesis and satiation of thirst.
D. Denton (1999)
10.1063/1.342489
Spatially and time‐resolved detection of gallium atoms formed in the laser photochemical vapor deposition process of trimethylgallium by laser‐induced fluorescence: Decomposition in the adsorbed state
H. Suzuki (1988)
10.1016/S0361-9230(98)00125-7
Connections of the rostral ventral respiratory neuronal cell group: an anterograde and retrograde tracing study in the rat
S. P. Gaytán (1998)
10.1016/S0140-6736(00)02534-4
Opioid use in last week of life and implications for end-of-life decision-making
A. Thorns (2000)
10.1378/CHEST.90.6.832
Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease.
G. Man (1986)
10.7326/0003-4819-132-6-200003210-00005
Understanding Economic and Other Burdens of Terminal Illness: The Experience of Patients and Their Caregivers
E. Emanuel (2000)
Caring for the elderly patient with cancer.
Dellefield Me (1986)
10.1002/ANA.410440516
Somatic and limbic cortex activation in esophageal distention: A functional imaging study
F. Binkofski (1998)
10.1073/PNAS.98.4.2035
Brain responses associated with consciousness of breathlessness (air hunger).
M. Liotti (2001)
10.1164/AJRCCM/148.5.1351
Exertional breathlessness in patients with chronic airflow limitation. The role of lung hyperinflation.
D. O'Donnell (1993)
10.1016/S0885-3924(98)00065-7
Dyspnea in the advanced cancer patient.
D. Dudgeon (1998)
10.1016/S0735-1097(96)00446-9
Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure.
T. P. Chua (1997)
10.1249/00005768-198205000-00012
Psychophysical bases of perceived exertion.
G. A. Borg (1982)
10.1097/00008483-199707000-00008
Acupressure as an adjunct to a pulmonary rehabilitation program.
Suh-hwa Maa (1995)
Lung cancer and dyspnea: the patient's perception.
M. Brown (1986)
10.1046/J.1365-2354.1999.00129.X
The experience of breathlessness in lung cancer.
M. O'Driscoll (1999)
10.1056/NEJM199512073332307
Pathophysiology of dyspnea.
H. Manning (2001)
10.1073/PNAS.98.4.2041
Neuroimaging evidence implicating cerebellum in the experience of hypercapnia and hunger for air.
L. Parsons (2001)
10.1093/oxfordjournals.qjmed.a067609
Diazepam in the treatment of dyspnoea in the 'Pink Puffer' syndrome.
P. Mitchell-Heggs (1980)
10.1164/AJRCCM.161.6.9910009
Inhaled furosemide greatly alleviates the sensation of experimentally induced dyspnea.
T. Nishino (2000)
10.1023/A:1008337624200
The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial.
C. Mazzocato (1999)
10.1093/BRAIN/121.5.931
Neural activation during acute capsaicin-evoked pain and allodynia assessed with PET.
M. Iadarola (1998)
10.1164/AJRCCM.165.1.2105061
"Tightness" sensation of asthma does not arise from the work of breathing.
A. Binks (2002)
Central processing of rectal pain: a functional MR imaging study.
M. Baciu (1999)
10.1164/AJRCCM.163.4.2005057
Neural substrates for the perception of acutely induced dyspnea.
C. Peiffer (2001)
10.1007/s005200050255
Management of dyspnea in advanced cancer patients
C. Ripamonti (1999)
10.1007/PL00007719
Palliative care in amyotrophic lateral sclerosis
G. Borasio (1997)
10.1164/AJRCCM/137.6.1285
The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease.
H. Liss (1988)
10.1152/JAPPL.1988.64.1.371
Effects of nasal cold receptors on pattern of breathing.
K. Burgess (1988)
10.1164/AJRCCM/139.1.126
Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease.
R. Light (1989)
10.1152/JAPPL.1993.74.2.590
Effects of naloxone on the sensation of dyspnea during acute respiratory stress in normal adults.
Y. Akiyama (1993)
10.1016/S1388-9842(02)00158-7
Morphine for the relief of breathlessness in patients with chronic heart failure—a pilot study
M. Johnson (2002)
10.1073/PNAS.96.8.4569
Neuroanatomical correlates of hunger and satiation in humans using positron emission tomography.
P. A. Tataranni (1999)
10.1136/bmj.326.7382.185
Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis
J. Lightowler (2003)



This paper is referenced by
10.1007/s10354-011-0046-z
Evaluation of diagnostic and treatment approaches towards acute dyspnea in a palliative care setting among medical students at the University of Vienna
G. Pohl (2011)
10.1007/978-1-4614-5164-8_16
Stroke, Epilepsy, and Neurological Diseases
María Gudín (2013)
10.12691/AJNR-2-3-2
Nursing Intervention for Management of Patients with Dyspnea at Emergency Units in Baghdad Hospitals
Ali D. Abbas (2014)
10.1007/s00520-008-0459-4
Use of palliative sedation for intractable symptoms in the palliative care unit of a comprehensive cancer center
A. Elsayem (2008)
10.1016/J.JPAINSYMMAN.2004.08.016
Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study.
E. Bruera (2005)
10.1177/0269216311415454
Do beta-blockers alter dyspnea and fatigue in advanced lung cancer? A retrospective analysis
P. Cameron (2012)
10.1053/J.SEMINONCOL.2004.11.019
Control of common, non-pain cancer symptoms.
J. V. Von Roenn (2005)
Nursing Intervention f or Management o f Patients w ith Dyspnea a t Emergency Units i n Baghdad Hospitals
Ali D. Abbas (2014)
10.1007/s005200100296
Respiratory problems in advanced cancer
C. Ripamonti (2002)
10.1053/j.seminoncol.2011.03.016
Pharmacologic management of cancer-related pain, dyspnea, and nausea.
W. Cheung (2011)
10.1089/JPM.2006.9.422
Symptom control in palliative care--Part III: dyspnea and delirium.
E. Del Fabbro (2006)
10.1007/s00520-007-0389-6
The management of dyspnea in cancer patients: a systematic review
R. Viola (2007)
10.1164/rccm.200605-587ST
An official American Thoracic Society clinical policy statement: palliative care for patients with respiratory diseases and critical illnesses.
P. Lanken (2008)
Manejo paliativo de la disnea por tamponade cardiaco: presentación de un caso
Silvia Allende-Pérez (2013)
10.1177/1049909110392204
Review Article: Palliative Care in Gynecologic Oncology
Y. Rezk (2011)
10.1007/s10354-009-0725-1
Pathophysiology and diagnosis of dyspnea in patients with advanced cancer
G. Pohl (2009)
10.1634/theoncologist.2011-0159
Symptom management in metastatic breast cancer.
W. Irvin (2011)
10.1016/J.MEDIPA.2014.05.002
Tratamiento sintomático de la disnea en fibrosis pulmonar idiopática: utilización de fentanilo inhalado en atención domiciliaria
Emilia Castro Rodriguez (2016)
10.1016/J.JPAINSYMMAN.2005.10.002
Oral transmucosal fentanyl citrate in the management of dyspnea crises in cancer patients.
M. A. Benítez-Rosario (2005)
10.1016/J.JPAINSYMMAN.2005.06.009
Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer.
A. Navigante (2006)
10.1016/B978-0-08-100348-0.00015-9
Food safety and older people.
M. A. Gettings (2009)
10.1016/j.jval.2011.04.008
Economic evaluation of everolimus versus sorafenib for the treatment of metastatic renal cell carcinoma after failure of first-line sunitinib.
R. Casciano (2011)
10.1016/j.jpainsymman.2015.06.016
Correlates and Predictors of Changes in Dyspnea Symptoms Over Time Among Community-Dwelling Palliative Home Care Clients.
S. Freeman (2015)
10.1016/J.CGER.2004.07.011
Last hours of living.
F. Ferris (2004)
10.1007/s00520-007-0310-3
Effect of hydromorphone on ventilation in palliative care patients with dyspnea
K. E. Clemens (2007)
10.1016/j.jpainsymman.2012.05.004
Management of moderate-to-severe dyspnea in hospitalized patients receiving palliative care.
P. Gomutbutra (2013)
10.1177/1049909108322286
Peaceful Surrender to Death Without Futile Bargaining to Live Relieves Terminal Air Hunger and Anguish
S. Das (2008)
10.3816/CLC.2006.N.001
Comprehensive symptom management in patients with advanced-stage non-small-cell lung cancer.
J. Temel (2006)
Management of refractory dyspnoea: evidence-based Interventions
P. Davidson (2010)
10.1016/J.JEUREA.2015.09.004
Comment soulager un patient dyspnéique en fin de vie
Sabine Voisin-Saltiel (2015)
10.1016/j.cger.2011.01.006
Nausea and other nonpain symptoms in long-term care.
M. Gonzales (2011)
10.12968/HMED.2009.70.4.41624
Symptom control and palliative care: management of breathlessness.
S. Oxberry (2009)
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