Dyspnea

Presentation: A subjective sensation of shortness of breath or discomfort with breathing that does not correlate with objective observations (RR, SpO2). Anxiety and dyspnea almost always occur together, and this can be very distressing to patients and families. 

Non-pharmacologic management: 

• Cool air with a fan (stimulates the trigeminal nerve; available at BCH by asking PACT)

• Comfortable and loose clothing

• Positioning, suctioning, cooling the room down

• Oxygen itself does not cause relief, but cool air may have effect

• CBT, guided imagery, relaxation exercises for anxiety

• Non-invasive PPV if within patient's goals of care

Pharmacologic management: 

• Treat reversible underlying causes: transfusions, radiation, drainage of ascites.

• Opioids are mainstay of therapy at 25-50% of dose required for analgesia.

  • Trial dose with lots of education to patient/family and staff

  • +/- anxiolytics

For more palliative care symptom management, please see PACT website