The management of dyspnoea in chronic heart failure

To identify current management options for dyspnoeic people with chronic heart failure (CHF).

Research in people with CHF studying dyspnoea as a primary endpoint remains sparse. However, attention is turning towards symptoms as well as survival, and the need for agreed outcome measurement is recognized. There is relevant recent work examining both pharmacological and nonpharmacological interventions, targeting breathlessness directly or indirectly. There is evidence to support exercise training and mindfulness based programmes. The safety of morphine for breathlessness in acute heart failure has been retrospectively analysed but controlled clinical trials are required. Sildenafil may be useful for dyspnoea in CHF due to reduction of peripheral muscle signalling. Rolophylline, relaxin, carperitide, nesiritide and steroids warrant further evaluation. Bronchodilator use for dyspnoea in acute heart failure in the absence of COPD should be used with caution. A recent Cochrane review highlights the importance of diuretic therapy for both symptom control and optimizing prognosis.

Better standardization of dyspnoea outcome measures should help comparison of future trials. Optimization of diuretic therapy and attempted correction of neurohormonal disturbance in CHF remain the therapeutic targets for the underlying cause in dyspnoea management.