Introduction to Breathlessness

Breathlessness is a common symptom in both malignant and non-malignant disease. Up to 70% patients with cancer experience breathlessness in the 6 weeks prior to death, and this may be greater in lung cancer patients because of co-existent chronic obstructive pulmonary disease (COPD).

Up to 40% of heart failure patients are breathless in the 6 months before death, rising to 65% in the three days leading up to death. Breathlessness is almost universal in patients with more than mild COPD or Interstitial Lung Disease (ILD). With very advanced disease, specific pharmacological treatment aimed at particular lung pathology (e.g. bronchodilators for bronchospasm) may have limited success and more general symptom control measures are often necessary.

The use of low dose opioids, titrated carefully, can help to relieve the sensation of breathlessness in patients with lung pathology, heart failure and cancer.

Oxygen therapy should not be used routinely. It may give symptom benefit if the patient is known to be hypoxic, including if they desaturate on exertion. For most, the use of a fan or other draught of air may be just as effective as oxygen.

Non-drug intervention may be of benefit in helping patients manage their symptoms; however, in advanced illness patients may often require opioid and/or benzodiazepine medication. These can be given by different routes of administration e.g. orally, sublingually (lorazepam), by continuous subcutaneous infusion via syringe driver/pump or bolus PRN dosing (subcutaneously or in exceptional circumstances intravenously).

DISCLAIMER

This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.