Dyspnea Review for the Palliative Care Professional: Assessment, Burdens, and Etiologies

Abstract

This article, the first in a two-part series, reviews the identification and assessment of dyspnea, the burden it entails, and the underlying respiratory and nonrespiratory etiologies that may cause or exacerbate it.

A collaborative approach to facilitate professionals to support the breathless patient

“…Brennan and Mazanec3 describe dyspnoea as a ‘complex, multidimensional, subjective symptom that can significantly impact patients' quality of life. A model of total dyspnoea4 supports this, demonstrating dyspnoea is affected by physical, psychological, spiritual and social aspects of a patient’s life.…”

Dyspnea Management in Early-Stage Lung Cancer

“…The impact of dyspnea on QOL in undeniable. Physically, this symptom is regarded as one of the most distressing, as the phenomenon of decreased oxygen lends to increased fatigue and breathlessness, and may be accompanied by discomfort, burning, numbness, or a feeling of impending death 25,26 . It impacts ability to sleep, work, exercise, and experience intimacy 27 .…”

Improving the management of dyspnea in the community using rapid learning approaches

“…For example, depression, fatigue, and overall health perception associate with dyspnea in patients with heart failure 16 ; spiritual distress has also been shown to correlate with dyspnea severity. 17 Following the lead of Saunders, Kamal et al 18 recently presented a mnemonic specific for dyspnea assessment and management whereby the biopsychosocial components can be recalled using 'dyspnea' as the acronym: D (depression); Y (yearning for peace, forgiveness, etc. ); S (social issues); P (physical problems); N (nonacceptance or spiritual/ existential distress); E (economic or financial distress); and A (anxiety and anger).…”

“…18 Research studies typically employ more complex measurements of physiologic parameters, such as the 6-min walking time, and surveys eliciting a report of the patient's symptom experience and severity (e.g. 'I feel out of breath,' 'My chest feels tight,' etc.).…”