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“I can’t breathe”: The Challenge of Dyspnea. Comprehensive Approach to Dyspnea Management Pawandeep Brar Palliative Care Physician. Objectives. Review Non-Pharmacological Treatment of Dyspnea Review Pharmacological Treatment of Dyspnea Review Interventional Approach to Dyspnea.

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i can t breathe the challenge of dyspnea

“I can’t breathe”: The Challenge of Dyspnea

Comprehensive Approach to Dyspnea Management

PawandeepBrar

Palliative Care Physician

objectives
Objectives
  • Review Non-Pharmacological Treatment of Dyspnea
  • Review Pharmacological Treatment of Dyspnea
  • Review Interventional Approach to Dyspnea
electrice fan
Electrice Fan
  • Simple interventions based on movement of air may relieve dyspnea for certain patients
    • An RCT of a hand-held electric fan directed toward the face versus toward the leg for 5 minutes showed significant decrease I dyspnea when the moving air was directed toward the face
oxygen therapy
Oxygen Therapy
  • Oxygen reverses dyspnea caused by hypoxemia
  • Limitations: many dyspneicpts are not hypoxemic
  • Hypoxemia is a weaker stimulus for dyspnea than hypercarbia
pharmacological approach opioids
Pharmacological Approach: Opioids
  • First line of therapy for symptomatic control
  • Opioid Receptors in central/peripheral nervous system as well as tracheobronchial tree
  • Effects postulated to be secondary to their effects on ventilatory response to carbon dioxide, hypoxia, inspiratory flow resistive loading
pharmacological approach opioids1
Pharmacological Approach: Opioids
  • Dosing of opioids:
    • If opioid naïve begin with low dose of 2.5-5mg morphine equivalent q4h & titrate to effect
    • If on opioids, increase current dose by 20-25% & titrate to effect
pharmacological approach opioids2
Pharmacological Approach:Opioids
  • Concerns re Opioids
  • fear of respiratory depression & accelerated death
    • Opioids have been used for many years to decrease dyspnea
    • Fear has been shown to be largely unfounded
pharmacological approach benzodiazapines
Pharmacological Approach: Benzodiazapines
  • Benzodiazepines are commonly prescribed for anxiety related to dyspnoea.
  • evidence for their effectiveness is not persuasive
  • treatment of anxiety does have a role in a subset of patients for whom it is a prominent component of the distress
pharmacological approach benzodiazepines
Pharmacological Approach: Benzodiazepines
  • Lorazepam: 0·5–1·0 mg/h orally until settled, then dose routinely every 4–6 h to keep settled
  • Diazepam: 5–10 mg/h orally until settled, and then dose routinely every 6–8 h
  • Clonazepam: 0·25-2·00 mg orally every 12 h
  • Midazolam: 0·5 mg intravenously per 15 min until settled, then by continuous subcutaneous or intravenous infusion
pharmacological approach other
Pharmacological Approach: Other
  • Glucocorticoids useful in bronchospasm, superior vena cava syndrome, carcinomatous lymphangitis and radiation pneumonitis.
  • Antibiotics may be appropriate for infections.
  • Anticoagulants can prevent and treat thrombotic pulmonary emboli.
  • Bronchodilators such as salbutamol and ipratropium treat reversible bronchospasm.
complementary approach
Complementary Approach
  • Counselling & support
  • Complementary therapies
    • Relaxation training
    • Tai chi
    • Yoga
    • Hypnosis
    • Therapeutic touch
    • accupuncture
interventional approach
Interventional Approach
  • Obstruction can be treated locally with laser therapy, cryotherapy, or stenting.
  • Malignant pleural effusions can be drained by thorocentesis, and if they recur, pleurodesismay be attempted. Fluid drainage may improve the mechanical advantage of the respiratory muscles to relieve dyspnoea.