An approach to dyspnea in advanced disease

To describe an approach to assessment and treatment of dyspnea.

New level I evidence can guide management of dyspnea in advanced illness. Assessment and use of adjuvant medications and oxygen relies on level II and III evidence.

Opioids are first-line therapy for managing dyspnea in advanced illness. They are safe and effective in reducing shortness of breath. Neuroleptics are useful adjuvant medications. Evidence does not support use of oxygen for every patient experiencing dyspnea; it should be tried for patients who do not benefit from first-line medications and nonmedicinal therapies.

Opioids relieve dyspnea and are indicated as first-line treatment for dyspnea arising from advanced disease of any cause.