Dyspnea

Abstract

Dyspnea, defined as uncomfortable or labored breathing, is a common and often devastating cause of distress for patients and their caregivers with advanced cancer and other life-threatening illnesses. The mechanism by which dyspnea develops is not fully understood, but it involves integration of the central respiratory complex with the sensory (perceptual) cortex. The gold standard of diagnosis is patient self-report. Careful assessment should be undertaken to identify reversible existing causes. Systemic opioids are the first-line therapy for symptomatic management, along with other general comfort measures (positioning, cool air, calming environment). Medical or surgical management can be directed toward underlying causes. Advanced care planning should include discussions concerning the burdens and benefits of medical/surgical management of underlying causes of dyspnea to more effectively direct goals of care. This article reviews current literature on dyspnea, with a focus on items published since 2000.

Morphine versus methylprednisolone or aminophylline for relieving dyspnea in patients with advanced cancer in China: a retrospective study

“…The medical terminology for breathlessness is dyspnea or respiratory depression (Williams 2006). People describe the feeling of breathless in different ways.…”

“…Dyspnea, or breathlessness, is a subjective sensation described as uncomfortable or unpleasant labored breathing (air hunger) (Williams 2006). It is a devastating symptom that frequently occurs in advanced cancer patients.…”

“…However, it is the most common in primary pulmonary carcinomas and in patients with metastatic lung disease (Parshall et al 2012). Almost 50–70% of patients with advanced cancer experience intractable dyspnea in the last 6 weeks, and dyspnea is the main symptom in more than 20% of patients within their final 48 h of life (Williams 2006; Parshall et al 2012; Navigante et al 2006). Symptoms such as loss of appetite, fatigue, pain, and dyspnea reduce the quality of life (QoL) in cancer patients (Polanski et al 2016).…”

“…The most effective measures to alleviate dyspnea are to address the underlying cause(s) of the breathlessness, such as resolving infection, controlling tumor growth, correcting anemia, and draining malignant pleural effusions (Williams 2006; Dy et al 2008). Nevertheless, there is often no discernable treatable cause or patients are not eligible for etiological treatment due to their poor clinical state and overall health.…”

Präklinische palliative Notfälle - Besonderheiten bei der therapeutischen Entscheidung

“…B. Sauerstoffsättigung, Atemfrequenz) können v. a. in der Palliativsituation nur Hinweise, aber keine sichere Korrelation für die Stärke und Behandlungsbedürftigkeit einer Luftnot sein [32]. Luftnot kann auch in der palliativen Krankheitssituation ein sehr plötzlich auftretendes Symptom sein, das sowohl vom Patienten als auch von seinen betreuenden Angehörigen als stark belastend empfunden werden kann [13,33,34]. Zusätzlich ist die durch die Symptomatik möglicherweise entstehende Todesangst / Panik gerade bei Palliativpatienten ein deutlich verstärkender Faktor, den es ebenfalls durch den Notarzt zu therapieren gilt [30,31].…”