TY - JOUR
T1 - Chronic refractory dyspnoea
T2 - Evidence based management
AU - Wiseman, Rachel
AU - Rowett, Debra
AU - Allcroft, Peter
AU - Abernethy, Amy
AU - Currow, David
PY - 2013/3
Y1 - 2013/3
N2 - 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.
AB - 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.
KW - Chronic obstructive pulmonary disease
KW - Dyspnoea
KW - Heart failure
KW - Lung diseases
KW - Neoplasms
KW - Palliative care
UR - http://www.racgp.org.au/afp/2013/march/chronic-refractory-dyspnoea/
UR - http://www.scopus.com/inward/record.url?scp=84875515140&partnerID=8YFLogxK
M3 - Article
SN - 0300-8495
VL - 42
SP - 137
EP - 140
JO - Australian Family Physician
JF - Australian Family Physician
IS - 3
ER -