[The treatment of terminal dyspnea]

Dyspnea can be defined as an unusual perception of respiration and/or urge to breath more than usual. Up to 70% of all tumour patients suffer at one time from this complaint, and often only an incomplete palliation is achieved. Dyspnea in the tumour patient is often associated with anxiety, which leads itself to a further exacerbation of dyspnea (through increased respiratory work and dead-space ventilation). A thorough evaluation should exclude treatable causes of dyspnea such as atelectasis, pleural effusions, pneumonias, congestive heart failure, pulmonary emboli, reversible exacerbations of coexisting obstructive lung disease, central tumour obstruction and pericardial effusion. Therapeutic measures include bronchoscopic suction of retained secretions and physical measures to reduce secretions. Supplemental oxygen is indicated in hypoxemic patients and in those who derive benefit of it. The nonspecific drug therapy with benzodiazepines and/or opiates remains clinically useful, although its efficacy is questioned by some controlled studies.