Approaches to Palliative Dyspnea Management in COPD. Todd Gale; February 24,2009. My Discussion. Issues affecting our management What is dyspnea? The evidence/lack of evidence A simplified treatment algorithm COPD Pearls. Topic #1. Issues affecting our management What is dyspnea?
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Todd Gale; February 24,2009
There is a gradual decline in health status punctuated by acute or crisis events which cause progressive deterioration and ultimately, but often unpredictably, death.
“exertional & incidental
Dyspnea = imbalance between the perceived need to breathe and the perceived ability to breathe.
(1)Treat the underlying cause of dyspnea as appropriate both
pharmacologically and non-
(2) Treat the distress associated with the dyspnea
Air flow vs oxygen flow?
There is some limited support for
factors + / - muscle weakness)
2. Treat and optimize using established therapies
(drugs, non-pharmacologic, medical, and surgical as appropriate)
All the interventions used for COPD/HF in those who aren’t dying
may also work in palliative care.
i.e. rate control for afib, digitalis, treat infections etc
3. Treat in the moment using your
A – Anxiety (also stand for Ativan)
B – Bronchodilators (COPD)
C – Contin : Short and long-acting opioids
D – Decadron / Diuretics (for COPD/CHF respectively)
E – Empathy and Explanation
F – Fan or fresh air
Assuming 1 second for inspiration…
Anxiety-affective interventions bronchodilators, +/-pursed-lip breathing,positioning-postural therapies….
1. Define the problem
2. Think of solutions and make a list
3. Try to find one that works. If it doesn’t work, try another
4. If none of your proposed solutions works after a reasonable effort, then consult an expert or try later
Things change. We learn from the past
Stay solution focused!
You can wake up now !