Management of Breathlessness
| Non-pharmacological measures | |
Sit the patient up (increases vital capacity and reduces abdominal splinting) Arrange cool airflow over the patient's face with a fan or by opening a window Maintain a calm empathic approach and presence Reassurance Physiotherapy Breathing/relaxation exercises Activity pacing Complementary therapies | |
| Pharmacological therapy | |
| Oxygen | May be helpful if patient is hypoxic (i.e. arterial SaO2<92%) |
| Beta-2 agonists | Give salbutamol by inhaler or nebuliser if there is bronchospasm. |
| Opioids | Start with oral morphine 1 mg as required, if tolerated and beneficial then consider using this regularly every 4 hrs and as required. After 2 days: calculate the total dose given over 24hrs, and use this to recalculate the 4-hourly dose (the new 4-hourly and ‘as required’ dose is one-sixth of the new total daily dose). Once a stable dose has been reached, this can be converted to once- or twice-daily modified-release morphine. If the patient is already on regular (analgesic) morphine: increase the dose of regular morphine by 30–50% every 2–3 days until symptoms are controlled, or adverse effects prevent further dose increases. |
| Anxiolytics | If anxiety-related breathlessness, consider use of long-term anxiolytic (e.g. citalopram). For panic-related breathlessness in patient approaching end of life then consider use of low dose lorazepam (0.5 mg to 1 mg up to 12-hourly). |