Palliative management of breathlessness

Breathlessness is a subjective experience of breathing discomfort and is one of the most common symptoms in patients receiving palliative care.

This paper reviews the palliative management of breathlessness.

Current management guidelines for the palliative management of breathlessness recommend treatment of reversible causes followed by non-pharmacological interventions such as breathing exercises, use of mobility aids, fans and focused psychological strategies. For those not responding, opioids might be considered with a reasonable starting dose being immediate release oral morphine 1-2.5 mg hourly as required (prn). Benzodiazepines, such as lorazepam 0.5 mg every 3-4 hours prn, might be used for the treatment of breathlessness-associated anxiety but do not a have role in the management of breathlessness per se. Systemic corticosteroids have limited evidence but can be considered in some cases. The use of home oxygen in patients who are non‑hypoxic lacks evidence but might be used after consideration of patient preferences. Patients might benefit from a breathlessness management plan.