Breathlessness in palliative care: a practical guide

Gillon, Suzie; Clifton, Ian

doi:10.12968/hmed.2019.80.2.72

Cited by 4 publications

(12 citation statements)

References 29 publications

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“…Gabapentin appears effective for refractory chronic cough and mucolytic agents may be useful in assisting with sputum clearance, but CTD‐ILD specific data are lacking 242,243 . Low‐dose opiates may be considered to palliate cough when alternative treatments have been unsuccessful 238,241,244 …”

Section: Special Considerations In Ctd‐ild Managementmentioning

confidence: 99%

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

et al. 2020

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Pulmonary complications in CTD are common and can involve the interstitium, airways, pleura and pulmonary vasculature. ILD can occur in all CTD (CTD-ILD), and may vary from limited, non-progressive lung involvement, to fulminant, life-threatening disease. Given the potential for major adverse outcomes in CTD-ILD, accurate diagnosis, assessment and careful consideration of therapeutic intervention are a priority. Limited data are available to guide management decisions in CTD-ILD. Autoimmunemediated pulmonary inflammation is considered a key pathobiological pathway in these disorders, and immunosuppressive therapy is generally regarded the cornerstone of treatment for severe and/or progressive CTD-ILD. However, the natural history of CTD-ILD in individual patients can be difficult to predict, and deciding who to treat, when and with what agent can be challenging. Establishing realistic therapeutic goals from both the patient and clinician perspective requires considerable expertise. The document aims to provide a framework for clinicians to aid in the assessment and management of ILD in the major CTD. A suggested approach to diagnosis and monitoring of CTD-ILD and, where available, evidence-based, diseasespecific approaches to treatment have been provided.

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Section: Special Considerations In Ctd‐ild Managementmentioning

confidence: 99%

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

et al. 2020

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“…(76) Dentre os efeitos colaterais da oxigenoterapia, destacam-se a hipercapnia aguda com efeitos centrais e a lesão pulmonar por estresse oxidativo que ocorre, em geral, com fluxos elevados de oxigênio. (77) O uso do equipamento pode também levar à restrição de atividades, ressecamento das mucosas e desconforto (6) Jacobs et al, (20) González-Moro et al, (25) O'Driscoll et al, (124) Chest Foundation (158) e American Association for Respiratory Care. (159) J Bras Pneumol.…”

Section: Odp Nas Doenças Crônicas Avançadas E Cuidados Paliativosunclassified

2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy

et al. 2022

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Some chronic respiratory diseases can cause hypoxemia and, in such cases, long-term home oxygen therapy (LTOT) is indicated as a treatment option primarily to improve patient quality of life and life expectancy. Home oxygen has been used for more than 70 years, and support for LTOT is based on two studies from the 1980s that demonstrated that oxygen use improves survival in patients with COPD. There is evidence that LTOT has other beneficial effects such as improved cognitive function, improved exercise capacity, and reduced hospitalizations. LTOT is indicated in other respiratory diseases that cause hypoxemia, on the basis of the same criteria as those used for COPD. There has been an increase in the use of LTOT, probably because of increased life expectancy and a higher prevalence of chronic respiratory diseases, as well as greater availability of LTOT in the health care system. The first Brazilian Thoracic Association consensus statement on LTOT was published in 2000. Twenty-two years la-ter, we present this updated version. This document is a nonsystematic review of the literature, conducted by pulmonologists who evaluated scientific evidence and international guidelines on LTOT in the various diseases that cause hypoxemia and in specific situations (i.e., exercise, sleep, and air travel). These recommendations, produced with a view to clinical practice, contain several charts with information on indications for LTOT, oxygen sources, accessories, strategies for improved efficiency and effectiveness, and recommendations for the safe use of LTOT, as well as a LTOT prescribing model.

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“…Thus, recognizing the value of mindbody interactions and applying the bio-psycho-social-spiritual model to provide holistic care can be an invaluable resource to further minimize dyspnea and other cancer-related symptomatology for many patients. 46,[74][75][76] Holistic, non-pharmacologic symptom control ranges broadly from breathing exercises to mindfulness techniques to music therapy to examining meaning within life. 76 Breathing exercises and breathing retraining have been helpful resources in combating dyspnea in patients with malignancy by emphasizing effective ventilation.…”

Section: Non-pharmacologic Management: Bio-psycho-social-spiritual In...mentioning

confidence: 99%

“…46,[74][75][76] Holistic, non-pharmacologic symptom control ranges broadly from breathing exercises to mindfulness techniques to music therapy to examining meaning within life. 76 Breathing exercises and breathing retraining have been helpful resources in combating dyspnea in patients with malignancy by emphasizing effective ventilation. 4,46 Particularly, inspiratory muscle training, 5 sessions per week for 3 months, is helpful in effectively managing dyspnea, increasing contentment with patient ability to manage dyspnea, reducing distress caused by dyspnea, and lowering depression.…”

Section: Non-pharmacologic Management: Bio-psycho-social-spiritual In...mentioning

confidence: 99%

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Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

Zemel

2021

Am J Hosp Palliat Care

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As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients’ dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.

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Breathlessness in palliative care: a practical guide

Cited by 4 publications

References 29 publications

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

Diagnosis and management of connective tissue disease‐associated interstitial lung disease in Australia and New Zealand: A position statement from the Thoracic Society of Australia and New Zealand*

2022 Brazilian Thoracic Association recommendations for long-term home oxygen therapy

Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

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