Breathlessness in Palliative Care

What can reversible causes of breathlessness be in palliative care?

Cardiac failure, COPD, infection, pleural effusion

What are some other causes of breathlessness in palliative care?

Anxiety, airway obstruction and excessive respiratory secretions

What are some practical advice for patients with breathlessness?

Breathing techniques, relaxation or directing a stream of air over the face

What can be used to treat underlying infections as the cause for breathlessness?

Antibiotics

What can be used if cardiac failure or pleural effusions are the cause for breathlessness?

Diuretics

What can be used for breathlessness in COPD in palliative care?

Corticosteroids or nebulised 0.9% NaCl

What can be used for breathlessness caused by anxiety for less than 2-4 weeks?

Benzodiazepines e.g., diazepam, lorazepam, midazolam

What can be used for breathlessness with anxiety lasting greater than 2-4 weeks?

SSRIs

What can be used for bronchospasm/partial obstruction breathlessness?

Dexamethasone

What can be used for obstruction as the cause for breathlessness in palliative care?

Palliative radiotherapy

What can be used for reversible bronchoconstriction for breathlessness in palliative care?

Bronchodilators

What can be used to reduce viscosity of secretions as a cause of breathlessness in palliative care?

Saline via nebulisers

What opioid can also be used for breathlessness?

Morphine

What forms of morphine can be used for breathlessness?

Up to 2mg a time of oral solution or 1mg SC for patients who cannot swallow

What should be done about patients already established on an opioid needing to use morphine for breathlessness?

Use breakthrough analgesic dose for relief of breathlessness

If patients are on a weak opioid e.g., codeine, tramadol and are experiencing breathlessness, what should they be switched to?

Equivalent morphine dosing

How many doses of opioids when used for all indications e.g., pain, breathlessness should trigger a dose review?

3

What is the benefit of using oxygen for breathlessness?

No additional benefit but patients like the sensation

When should oxygen be used in patients with palliative care?

Patients with severe hypoxia or those who report significant relief from use of oxygen

What is the NICE recommendation of managing breathlessness?

Opioid or benzodiazepine or combination of both

What are some non-pharmacological ways of managing breathlessness?

• Draught of air from fan or open window

• Position of bed - upright to assist lung expansion, lying on side for secretions and body bent forward relaxes upper chest muscles

• Physiotherapy - breathing techniques to optimise breathing, chest wall vibration and walking aids

• Occupational therapy

• Energy conservation techniques, pacing of activities, help with prioritisation

• Relaxation techniques

• CBT

• Complementary therapies e.g., acupuncture

• MDT breathlessness