Non-opioid medications for the relief of chronic breathlessness: current evidence

Barbetta, Carlo; Currow, David C.; Johnson, Miriam J.

doi:10.1080/17476348.2017.1305896

Cited by 9 publications

(5 citation statements)

References 69 publications

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“…Based on a postulate of downward spiral of health resulting from curative-intent therapy (E- Figure 1), efforts to improve physical exercise, function, and QoL in lung cancer survivors may need to first optimize medical therapy for cardiopulmonary disease [41] and possibly psychiatric illness [42] to alleviate dyspnea to be effective. Recent randomized controlled trials in COPD patients show that combination bronchodilator inhaler therapy is effective in reducing dyspnea [43] and possibly in improving physical activity [44,45].…”

Section: Discussionmentioning

confidence: 99%

Characterization of Dyspnea in Lung Cancer Survivors Following Curative-Intent Therapy

Ries

2018

Preprint

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word count 250)Purpose Dyspnea is highly-prevalent in lung cancer survivors following curative-intent therapy. We aimed to identify clinical determinants of dyspnea and characterize its relationship with functional exercise capacity (EC). MethodsIn an analysis of data from a cross-sectional study of lung cancer survivors who completed curative-intent therapy for stage I-IIIA disease ≥1 month previously, we tested a thorough list of comorbidities, lung function, and lung cancer characteristics. We assessed dyspnea using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Lung Cancer Module 13 (LC13) and functional EC the six-minute walk. We verified results with the University of California San Diego Shortness of Breath Questionnaire (SOBQ). ResultsIn 75 participants at a median of 12 months since completing treatment, the mean (SD) LC13-Dyspnea score was 35.3 (26.2); 60% had abnormally-high dyspnea. In multivariable linear regression analyses, significant clinical determinants of dyspnea were [β (95% confidence interval)]: psychiatric illness [-20.8 (-32.4, -9.09) for No/Yes], heart failure with reduced ejection fraction [-15.5 (-28.0, -2.97) for No/Yes], and forced expiratory volume in 1 second [-0.28 (-0.49, -0.06) for each % predicted]. Dyspnea was an independent predictor of functional EC [-1.54 (-2.43, -0.64) for each point]. These results were similar with the SOBQ.Conclusion

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Section: Discussionmentioning

confidence: 99%

Characterization of Dyspnea in Lung Cancer Survivors Following Curative-Intent Therapy

Ries

2018

Preprint

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“…A recent phase 3 placebo-controlled randomised controlled trial of sertraline failed to demonstrate benefit over placebo [65]. Benzodiazepines are used appropriately for dying patients [66] but their dependency potential and lack of evidence for effectiveness makes them unsuitable for long-term use for symptom control. Furosemide and cannabinoids show promise [67] but will not be further discussed as they are not used outside trials.…”

Section: Breathlessnessmentioning

confidence: 99%

Improving the quality of life of people with advanced respiratory disease and severe breathlessness

Booth

Johnson

2019

Breathe

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Advanced respiratory disease imposes a greater symptom burden than many cancers but not does have comparable recognition of the need for supportive and palliative care or the infrastructure for its systematic delivery. Consequently, many people with advanced respiratory disease (and those closest to them) have a poor quality of life, disabled by chronic breathlessness, fatigue and other symptoms. They are socially isolated by the consequences of long-term illness and are often financially impoverished. The past decade has seen an increasing realisation that care for this group must improve and that symptom management must be prioritised. Clinical guidelines recommend person-centred care, including access to supportive and palliative care as needed, as part of standard medical practice. Advanced lung disease clinics and specialist breathlessness services (pioneered within palliative care) are developing within respiratory medicine services but are provided inconsistently.This review covers the comprehensive assessment of the patient with advanced respiratory disease, the importance of supporting carers and the current best practice in the management of breathlessness, fatigue and cough. It also suggests ways to incorporate person-centred care into the general respiratory clinic, assisted by better liaison with specialist palliative and primary care. Emerging evidence shows that excellent symptom management leads to better clinical outcomes and reduces inappropriate use of emergency medical services.Key pointsPeople living with advanced respiratory disease and severe chronic breathlessness (and those closest to them) have a poor quality of life.Chronic breathlessness is a disabling symptom, and acute-on-chronic/episodic breathlessness is frightening to experience and observe.Chronic breathlessness imposes profound physical limitations and psychosocial burdens on those suffering from it or living with someone experiencing it.Fatigue and cough are two other cardinal symptoms of advanced respiratory disease, with very detrimental effects on quality of life.The impact of all these symptoms can be alleviated to a variable extent by a predominantly non-drug complex intervention.Many of the interventions are delivered primarily by allied health or nursing professionals.Doctors, nurses and other health professionals also need to play an active part in promoting quality of life as part of excellent medical care.A person-centred, psychologically informed approach is needed by all clinicians treating patients with advanced respiratory disease.Educational aimsTo give specialist respiratory clinicians practical clinical tools to help improve the quality of life of their patients with advanced respiratory disease and chronic breathlessness.To outline the evidence base for these interventions with reference to definitive sources.To highlight the importance of person-centred care in people with respiratory disease at all stages of illness.

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“…15 A subsequent review of non-opioid therapies in chronic breathlessness also found insufficient evidence to support benzodiazepine use. 16 Benzodiazepines thus cannot be recommended for routine use in treating breathlessness, but can be considered as second-or third-line treatment when symptoms are refractory to other management including opioids.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Updates in palliative care – recent advancements in the pharmacological management of symptoms

Star

Boland

2018

Clinical Medicine

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Symptom management is an important part of both palliative care and end-of-life care. This article will examine the recent research evidence about drugs commonly used for symptom management in adult patients receiving palliative care. In particular, the management of symptoms where recent palliative care-based evidence has changed recommended practice will be reviewed. This includes: breathlessness, delirium, nausea and vomiting in bowel obstruction, opioidinduced constipation and upper respiratory tract secretions. For each symptom, a review of recent pharmacological evidence has been undertaken, with emphasis on potential important changes to physicians' practice.

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Non-opioid medications for the relief of chronic breathlessness: current evidence

Cited by 9 publications

References 69 publications

Characterization of Dyspnea in Lung Cancer Survivors Following Curative-Intent Therapy

Characterization of Dyspnea in Lung Cancer Survivors Following Curative-Intent Therapy

Improving the quality of life of people with advanced respiratory disease and severe breathlessness

Updates in palliative care – recent advancements in the pharmacological management of symptoms

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