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Professional Management
Reviewed: December 2006
 Breathlessness inhibits the patient's ability to engage in normal activities which can lead to social isolation and decreased quality of life. As with pain, the patient is the only one who is able to determine the level of breathlessness experienced. Because dyspnea can have serious consequences, it is important that you keep your doctor, nurse or pharmacist informed about your physical condition at all times.
Communication is Key:
Always tell your doctor, nurse, or pharmacist about any unusual or disturbing symptoms that you experience. Even at different times and under different circumstances you may feel varying levels of dyspnea with the same condition.
Communication with your health care team and family is necessary for best management of dyspnea. The use of a consistent dyspnea scale (0 = no dyspnea, 10 = worst dyspnea imaginable) helps to best communicate the intensity of dyspnea a patient experiences.
|
Breathlessness Intensity Scale |
| 0 |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
9 |
10 |
| 1 |
1 |
1 |
| No Breathlessness |
Moderate Breathlessness |
Worst Breathlessness |
Other Important Questions:
- When did the dyspnea begin?
- What have you tried to relieve the dyspnea?
- What makes your dyspnea worse?
- Describe what your shortness of breath looks like?
- Do you feel exhausted or fatigued?
- Are you able to do your daily activities?
- Is your shortness of breath associated with meals or daily activities, or any of the medications you are taking?
How Do We Identify Dyspnea
History should include:
- Your self report of breathlessness to measure the severity of dyspnea. The use of visual analogue scale (0-10 scale) mentioned earlier is essential to use in describing dynspea (breathlessness).
- A physical examination by a nurse or a doctor including an assessment of the rate, depth, and pattern of your respirations is important in order to treat dyspnea.
- The impact of the breathlessness on your quality of life.
- Alleviating and exacerbating factors such as daily activities, walking, or exercising.
- The meaning person attaches to the breathlessness (ie. "I'm constantly gasping" or "I feel helpless", or "I feel like I am choking").
Medications for Dyspnea
As with pain, dyspnea is managed in accordance with what is causing it. The most appropriate treatment of breathlessness is determined following a thorough history, physical exam and diagnostic tests. Dyspnea or breathlessness can be caused by:
- Advanced and/or acute illnesses that prevent airflow such as chronic diseases including asthma, emphysema and pulmonary embolisms.
- Changes in compliance &/or capacity of the lungs that interfere with the workload of breathing such as interstitial fibrosis, congestive heart failure, intrinsic respiratory muscle weakness, ascites, pleural effusions and superior vena cava obstruction.
- Airwary obstruction resulting from tumours of the trachea, larynx, thyroid, mediastinum, bronchus as well as traheoesophageal fistulas and pulmonary embolisms.
- Some treatment induced conditions including radiation of the lungs or chemotherapy damage, infections and anemia.
Your care team will spend some time trying to find out what makes you breathless in order to match the right medication with the right cause. Often, patient's dyspnea will be caused by more than one thing, therefore you may need to be treated with more than one medication. Here are a list of some medications used for dyspnea:
- Many health care providers oppose the use of opiates for dyspnea. This opposition comes from a lack of knowledge of the effectiveness of opioids for dyspnea, lack of clinical experience using opioids to treat dyspnea and a reflexive avoidance of any drug that potentially depresses respirations.
- Corticosteroid medications can decrease exercise-induced shortness of breath, shortness of breath due to airway obstruction, chronic pulmonary disease and radiation pneumonitis.
- Bronchodilators and expectorants can be used to treat "asthma-like" symptoms and to increase the patient's ability to cope with breathlessness.
- Anxiolytic agents such as benzodiazepines can be used to treat anxiety which may increase breathlessnes, therefore caution should be used because some patients may experience these medications as increasing anxiety, not decreasing it. Midazolam is a powerful anxiolytic usually reserved for severe dyspnea.
- Diuretics can be considered if an underlying cause is associated with increasing volumes.
- Anticholinergics such as scopolamine or atropine can be used to decrease secretions but only if death is imminent.
- Oxygen - although the use of oxygen for dyspnea may not have a large physiologic benefit, family members and patients may find some psychological comfort with the use of oxygen.
The BC Cancer Agency maintains a database on commonly used unconventional therapies available to cancer patients.
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