Management of Moderate-to-Severe Dyspnea in Hospitalized Patients Receiving Palliative Care

Gomutbutra, Patama; Pantilat, Steven Z.

doi:10.1016/j.jpainsymman.2012.05.004

Cited by 26 publications

(14 citation statements)

References 18 publications

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“…There are a few other studies which have looked at change in symptoms within 24 h of palliative care consultation and shown improvement [8,14,18], but most studies have looked at improvement over a longer time frame, ranging between 3 days after consultation and the time of discharge [9][10][11][12][13]15,16]. This finding is particularly relevant for a few reasons.…”

Section: Discussionmentioning

confidence: 99%

“…Our scale is compressed from the original eleven point scale (0-10) to a four point scale (0-3) representing symptom intensity of none, mild, moderate or severe. The 0-3 scale has also been used in prior studies of palliative care provision for symptom management [8,15,16]. We have data for the following symptoms: pain, anorexia, fatigue, depression, anxiety, nausea and shortness of breath.…”

Section: Methodsmentioning

confidence: 99%

“…Prior studies of impact of inpatient palliative care consultation on symptom burden have included few or no gynecologic cancer patients [8][9][10][11][12][13][14][15][16][17][18]. Though they have varied widely in patient population, scale used to measure symptoms, outcome definitions and time frame over which changes in symptoms are measured, these studies have established an association between inpatient palliative care consultation and improved symptom burden.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients

Lefkowits

Teuteberg

Courtney‐Brooks

et al. 2015

Gynecologic Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients

Lefkowits

Teuteberg

Courtney‐Brooks

et al. 2015

Gynecologic Oncology

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“…Our data therefore probably tend to underestimate the frequency of this phenomenon, because less severe episodes probably went unrecorded. This underestimation may have been further accentuated by the widespread use of opioids and anxiolytics in the PCH, a combination that has been shown to be effective at reducing the sensation of dyspnea . It is particularly interesting that most of the dyspnea episodes occurred in the last few days of life, a period during which 70% of patients have opioid treatment, which may mask some dyspnea episodes (F. Guirimand; pers.…”

Section: Discussionmentioning

confidence: 99%

Sequential occurrence of dyspnea at the end of life in palliative care, according to the underlying cancer

et al. 2015

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Dyspnea is a symptom that severely affects the quality of life of terminally ill patients. Its frequency differs considerably between studies. We aimed to characterize the frequency of dyspnea in a palliative care hospital (PCH) and to identify factors predisposing to dyspnea, particularly during the very last days of life, as a function of the underlying disease. Episodes of dyspnea were identified by the computerized extraction of prospectively collected data from the reports of care assistants or from medical observations recorded in the medical files for all stays at our PCH during the last 6 years. There were 6455 hospital stays, 88% ending in the death of the patient; 13,282 episodes of dyspnea were recorded during 2608 hospital stays (40%). Dyspnea was more frequently observed in cases of cancer than in other conditions (RR = 1.30; 95% CI: 1.14–1.48). Pulmonary metastasis increased the risk of dyspnea from 37% to 51% (RR = 1.37; 95% CI: 1.29–1.46). Dyspnea frequency varied with the primary cancer site, from 24% (brain cancer) to 60% (esophageal cancer). The data for cancer patients staying for more than 6 days who subsequently died indicated that 8% of patients experienced dyspnea exclusively during the last 4 days of the life, independently of the site of the primary cancer. Dyspnea during the last few days of life requires systematic assessment. Exclusively terminal dyspnea should be distinguished from more precocious dyspnea, as the pathophysiological mechanisms and treatments of these two forms are probably different.

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“…Continuous intravenous infusion of an opioid can be used for end of life care [79]. Anxiolytic medications are often prescribed along with opioids as combined modalities to palliate patients who experience refractory dyspnea [80].…”

Section: Opioids For Refractory Dyspneamentioning

confidence: 99%

Opioids for refractory dyspnea

Mahler¹

2013

Expert Review of Respiratory Medicine

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Refractory dyspnea is breathing difficulty that persists at rest or with minimal activity despite optimal therapy of the underlying condition. Both endogenous (β-endorphin) and exogenous (morphine) opioids modulate the perception of dyspnea by binding to opioid receptors. Proposed mechanisms whereby opioids relieve refractory dyspnea include: decreasing respiratory drive with an associated decrease in corollary discharge; altering central perception; altering activity of peripheral opioid receptors located in the lung and decreasing anxiety. As patients respond variably to opioid therapy, a low dose of an opioid should be prescribed initially to manage refractory dyspnea. The dose should be titrated to achieve the lowest effective dose based on patient ratings of breathing difficulty. Research is needed to address clinical uncertainties and to identify genetic factors to improve the use of opioids to relieve refractory dyspnea. Medscape: Continuing Medical Education OnlineThis activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Expert Reviews Ltd. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test with a 70% minimum passing score and complete the evaluation at www.medscape.org/journal/expertrespiratory; (4) view/print certificate. Learning objectivesUpon completion of this activity, participants will be able to:• Describe proposed mechanisms for the effect of systemic opioids in relieving refractory dyspnea, based on a review • Describe management of refractory dyspnea with systemic opioids, based on a review • Describe barriers to opioid use for management of refractory dyspnea and directions for future research

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Management of Moderate-to-Severe Dyspnea in Hospitalized Patients Receiving Palliative Care

Cited by 26 publications

References 18 publications

Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients

Improvement in symptom burden within one day after palliative care consultation in a cohort of gynecologic oncology inpatients

Sequential occurrence of dyspnea at the end of life in palliative care, according to the underlying cancer

Opioids for refractory dyspnea

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