DYSPNOEA IN PALLIATIVE CARE THE WHY, WHAT AND HOW FOR PRIMARY CARE PHYSICIANS
- Author:
Laurence Lean Chin Tan
- Publication Type:Journal Article
- Keywords:
Palliative Care;
Dyspnoea;
Family Physicians
- From:The Singapore Family Physician
2016;42(3):42-44
- CountrySingapore
- Language:English
-
Abstract:
Dyspnoea is the subjective experience of breathing
discomfort, made up of distinct sensations varying in
intensity. It is caused by multiple factors in palliative
patients, such as infections, anaemia or anxiety. Tools
like the Visual Analogue Scale (VAS), Numerical Rating
Scale (NRS) and the Modified Borg scale, together with
Functional Assessment Scales like the Medical Research
Council Dyspnoea Scale and Baseline Dyspnoea Index
(BDI) are used to measure the severity of Dyspnoea.
Oxygen therapy can provide comfort for patients and
can increase survival in selected COPD patients. An
N=1 trial of supplemental oxygen is encouraged for
patients with dyspnoea.Other non-pharmacological
interventions such as breathing training and walking
aids have been proven to be effective in managing
dyspnoea. Studieshave shown that oral or parenteral
opioids are useful for relieving dyspnoea. They are safe
to use in titrated doses. However, morphine should be
used cautiously in patients with impaired renal and
liver functions. Benzodiazepines are not recommended
for first-line treatment, and should be administered
after consult with a palliative physician. Effort should
always be made to correct reversible causes.Family
education is important to alleviate the stress of caring
for patients with dyspnoea.
