DYSPNOEA IN PALLIATIVE CARE THE WHY, WHAT AND HOW FOR PRIMARY CARE PHYSICIANS

ABSTRACT

Dyspnoea is the subjective experience of breathing discomfort, made up of distinct sensations varying in intensity. It is caused by multiple factors in palliative patients, such as infections, anaemia or anxiety. Tools like the Visual Analogue Scale (VAS), Numerical Rating Scale (NRS) and the Modified Borg scale, together with Functional Assessment Scales like the Medical Research Council Dyspnoea Scale and Baseline Dyspnoea Index (BDI) are used to measure the severity of Dyspnoea. Oxygen therapy can provide comfort for patients and can increase survival in selected COPD patients. An N=1 trial of supplemental oxygen is encouraged for patients with dyspnoea.Other non-pharmacological interventions such as breathing training and walking aids have been proven to be effective in managing dyspnoea. Studieshave shown that oral or parenteral opioids are useful for relieving dyspnoea. They are safe to use in titrated doses. However, morphine should be used cautiously in patients with impaired renal and liver functions. Benzodiazepines are not recommended for first-line treatment, and should be administered after consult with a palliative physician. Effort should always be made to correct reversible causes.Family education is important to alleviate the stress of caring for patients with dyspnoea.