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Acute Dyspnoea

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Textbook of Palliative Care

Abstract

Acute (or episodic) dyspnoea is a debilitating symptom that induces fear and anxiety in patients and family/carers alike. Management focuses on addressing the underlying cause where this can be identified. In addition to addressing reversible causes, management of acute dyspnoea or a dyspnoea crisis will be discussed. Evidence for both pharmacological and non-pharmacological management strategies is outlined, with discussion of how these can be incorporated into a comprehensive, individualized management plan. Involvement and education of the wider interdisciplinary team across healthcare settings is essential. This chapter will also cover some of the more specific causes of acute dyspnoea such as anxiety or breathing pattern disorders, stridor or upper airway obstruction, bronchospasm, and the sensation of choking with a focus on neuromuscular diseases.

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References

  • Abernethy AP, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376:784–93.

    Article  Google Scholar 

  • Bailey PH. The dyspnea-anxiety-dyspnea cycle- COPD patients’ stories of breathlessness: “it’s scary when you can’t breathe”. Qual Health Res. 2004;14(6):760–78.

    Article  Google Scholar 

  • Banfi P, et al. A review of options for treating sialorrhea in amyotrophic lateral sclerosis. Respir Care. 2015;60(3):446–54.

    Article  Google Scholar 

  • Boulding R, et al. Dysfunctional breathing: a review of the literature and proposal for classification. Eur Respir Rev. 2016;25:287–94.

    Article  Google Scholar 

  • Cabezon-Gutierrez L, et al. Opioids for management of episodic breathlessness or dyspnea in patients with advanced disease. Support Care Cancer. 2016;24:4045–55.

    Article  Google Scholar 

  • Cates CJ, et al. Holding chambers (spacers) versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Database Syst Rev. 2013;9:CD000052.

    Google Scholar 

  • Chang AS, et al. Prospective use of descriptors of dyspnea to diagnose common respiratory diseases. Chest. 2015;148(4):895–902.

    Article  Google Scholar 

  • Currow DC, et al. Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study. J Pain Symptom Manage. 2010;39(4):680–90.

    Article  Google Scholar 

  • Diehl JL, et al. Helium in the adult critical care setting. Ann Intensive Care. 2011;1:24.

    Article  Google Scholar 

  • Ek K, et al. “The unpredictable death” – the last year of life for patients with advanced COPD: relatives stories. Palliat Support Care. 2015;13:1213–22.

    Article  Google Scholar 

  • Farquar M, et al. Six key topics informal carers of patients with breathlessness in advanced disease want to learn about and why: MRC phase 1 study to inform an educational intervention. PLoS One. 2017;12(5):e0177081.

    Article  Google Scholar 

  • Flockton RJ, et al. Use of nebulised adrenaline in the management of steroid resistant stridor. Palliat Med. 2007;21:723–4.

    Article  Google Scholar 

  • Giacomini M, et al. Experiences of living and dying with COPD: a systematic review and synthesis of the qualitative empirical literature. Ont Health Technol Assess Ser. 2012;12(13):1–47.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Godbout K, et al. A distress protocol for respiratory emergencies in terminally ill patients with lung cancer or chronic obstructive pulmonary disease. Am J Hosp Palliat Med. 2016;33(9):817–22.

    Article  Google Scholar 

  • Guibert N, et al. Techniques of endoscopic airway tumour treatment. J Thorac Dis. 2016;8(11):3343–60.

    Article  Google Scholar 

  • Gysels MH, Higginson IJ. The lived experience of breathlessness and its implications for care: a qualitative comparison in cancer, COPD, heart failure and MND. BMC Palliat Care. 2011;10:15.

    Article  Google Scholar 

  • Hadjikoutis S, et al. Coughing and choking in motor neuron disease. J Neurol Neurosurg Psychiatry. 2000;68:601–4.

    Article  CAS  Google Scholar 

  • Hardy J, et al. A randomised, double-blind controlled trial of intranasal midazolam for the palliation of dyspnoea in patients with life-limiting disease. Support Care Cancer. 2016;24(7):3069–76.

    PubMed  Google Scholar 

  • Harris P, Nagy S, Vardaxis N. Mosby’s dictionary of medicine, nursing and health professions. Marrickville: Elsevier; 2014.

    Google Scholar 

  • Hearson, et al. Sleeping with one eye open: the sleep experience of family members providing palliative care at home. J Palliat Care. 2011;27(2):69–78.

    PubMed  Google Scholar 

  • Hutchinson A, et al. Breathlessness and presentation to the emergency department: a survey and clinical record review. BMC Pulm Med. 2017;17:53–9.

    Article  Google Scholar 

  • Janssens, et al. Dyspnoea perception in COPD: association between anxiety, dyspnoea-related fear and dyspnoea in a pulmonary rehabilitation program. Chest. 2011;140(3):618–25.

    Article  Google Scholar 

  • Jennings AL, et al. A systematic review of the use of opioids in the management of dyspnoea. Thorax. 2002;57:939–44.

    Article  Google Scholar 

  • Linkins LA, Takach Lapner S. Review of D dimer testing: good, bad and ugly. Int J Lab Hematol. 2017;39(Suppl 1):98–103.

    Article  Google Scholar 

  • LOTT Group. A randomised trial of long-term oxygen for COPD with moderate desaturation. N Engl J Med. 2016;375:1617–27.

    Article  Google Scholar 

  • Luckett T, et al. Content and quality of websites supporting self-management of chronic breathlessness in advanced illness: a systematic review. Prim Care Respir Med. 2016;26:16025.

    Article  Google Scholar 

  • MacPherson A, et al. The views of patients with severe chronic obstructive pulmonary disease on advance care planning: a qualitative study. Palliat Med. 2012;27(3):265–72.

    Article  Google Scholar 

  • McGeachen AJ, et al. A multicentre evaluation of oropharyngeal secretion management practices in amyotrophic lateral sclerosis. Amyotroph Lateral Scler Frontotemporal Degener. 2017a;18:1–9.

    Article  Google Scholar 

  • McGeachen AJ, et al. Management of oral secretions in neurological disease. Pract Neurol. 2017b;17:96–103.

    Article  Google Scholar 

  • Mularski, et al. An official American thoracic society workshop report: assessment and palliative management of dyspnea crisis. Ann Am Thorac Soc. 2013a;10(5):S98–S106.

    Article  Google Scholar 

  • Mularski, et al. ATS dyspnoea crisis supplementary methods document and evidence summary. Ann Am Thorac Soc. 2013b;10(5). Online supplement date of access 7th Feb 2017.

    Google Scholar 

  • Neudert C, et al. The course of the terminal phase in patients with amyotrophic lateral sclerosis. J Neurol. 2001;248:612–6.

    Article  CAS  Google Scholar 

  • Ost DE, et al. Therapeutic bronchoscopy for malignant central airway obstruction. Chest. 2015;147(5):1282–98.

    Article  Google Scholar 

  • Parshall MB, et al. Dyspnea duration, distress and intensity in emergency department visits for heart failure. Heart Lung. 2001;30(1):47–56.

    Article  CAS  Google Scholar 

  • Parshall MB, et al. An official ATS society statement: update on the mechanisms, assessment and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435–52.

    Article  Google Scholar 

  • Reddy SK, et al. Characteristics and correlates of dyspnoea in patients with advanced cancer. J Palliat Med. 2009;12(1):29–36.

    Article  Google Scholar 

  • Remi C, et al. Pharmacological management of bronchorrhea in malignant disease: a systematic literature review. J Pain Symptom Manage. 2016;51(5):916–25.

    Article  Google Scholar 

  • Simon ST, et al. Episodic and continuous breathlessness: a new categorization of breathlessness. J Pain Symptom Manage. 2013a;45(6):1019–29.

    Article  Google Scholar 

  • Simon ST, et al. Episodic breathlessness in patients with advanced disease: a systematic review. J Pain Symptom Manage. 2013b;45(3):561–77.

    Article  Google Scholar 

  • Simon ST, et al. Episodes of breathlessness: types and patterns – a qualitative study exploring experiences of patients with advanced diseases. Palliat Med. 2013c;27(6):524–32.

    Article  Google Scholar 

  • Simon ST, et al. Fentanyl for the relief of refractory breathlessness: a systematic review. J Pain Symptom Manage. 2013d;46(6):874–86.

    Article  Google Scholar 

  • Simon ST, et al. Definition, categorization, and terminology of episodic breathlessness: consensus by and international Delphi survey. J Pain Symptom Manage. 2014;47(5):828–38.

    Article  Google Scholar 

  • Simon ST, et al. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2016;10:Art no CD007354.

    Google Scholar 

  • Smith SW, Biros M. Relief of imminent respiratory failure from upper airway obstruction by use of helium-oxygen: a case series and brief review. Acad Emerg Med. 1999;6(9):953–6.

    Article  CAS  Google Scholar 

  • Weingartner V, et al. Characterizing episodic breathlessness in patients with advanced disease. J Palliat Med. 2013;16(10):1275–9.

    Article  Google Scholar 

  • Weingartner V, et al. Characteristics of episodic breathlessness as reported by patients with advanced chronic obstructive pulmonary disease and lung cancer: results of a descriptive cohort study. Palliat Med. 2015;29(5):420–8.

    Article  Google Scholar 

  • Wimalasena Y, et al. Lung ultrasound: a useful tool in the assessment of the dyspnoeic patient in the emergency department. Fact or fiction? Emerg Med J. 2017;0:1–9.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Canterbury District Health Board, Christchurch, New Zealand

    Rachel Wiseman

  2. Christchurch Hospital Palliative Care Service, Christchurch, New Zealand

    Rachel Wiseman

Authors
  1. Rachel Wiseman
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Correspondence to Rachel Wiseman .

Editor information

Editors and Affiliations

  1. HammondCare Learning and Research Centre, Greenwich Hospital, Greenwich, New South Wales, Australia

    Roderick Duncan MacLeod

  2. Vrije Universiteit Brussel, VUB-UGent End-of-Life Care Research Grou Vrije Universiteit Brussel, Brussels, Belgium

    Lieve van den Block

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Wiseman, R. (2018). Acute Dyspnoea. In: MacLeod, R., van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-31738-0_80-1

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  • DOI: https://doi.org/10.1007/978-3-319-31738-0_80-1

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-31738-0

  • Online ISBN: 978-3-319-31738-0

  • eBook Packages: Springer Reference Biomedicine and Life SciencesReference Module Biomedical and Life Sciences

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