Chronic refractory dyspnoea: Evidence based management

Rachel Wiseman, Debra Rowett, Peter Allcroft, Amy Abernethy, David Currow

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    27 Citations (Scopus)


    Background: Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases. Objective: To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe, symptomatic management of chronic refractory dyspnoea. Discussion: Dyspnoea is mostly multifactorial. Each reversible cause should be managed (Level 4 evidence). Non-pharmacological interventions include walking aids, breathing training and, in chronic obstructive pulmonary disease, pulmonary rehabilitation (Level 1 evidence). Regular, low dose, sustained release oral morphine (Level 1 evidence) titrated to effect (with regular aperients) is effective and safe. Oxygen therapy for patients who are not hypoxaemic is no more effective than medical air. If a therapeutic trial is indicated, any symptomatic benefit is likely within the first 72 hours.

    Original languageEnglish
    Pages (from-to)137-140
    Number of pages4
    JournalAustralian Family Physician
    Issue number3
    Publication statusPublished - Mar 2013


    • Chronic obstructive pulmonary disease
    • Dyspnoea
    • Heart failure
    • Lung diseases
    • Neoplasms
    • Palliative care


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