Chronic refractory dyspnoea--evidence based management.


Journal Article (Review)

BACKGROUND: Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases. OBJECTIVE: To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe, symptomatic management of chronic refractory dyspnoea. DISCUSSION: Dyspnoea is mostly multifactorial. Each reversible cause should be managed (Level 4 evidence). Non-pharmacological interventions include walking aids, breathing training and, in chronic obstructive pulmonary disease, pulmonary rehabilitation (Level 1 evidence). Regular, low dose, sustained release oral morphine (Level 1 evidence) titrated to effect (with regular aperients) is effective and safe. Oxygen therapy for patients who are not hypoxaemic is no more effective than medical air. If a therapeutic trial is indicated, any symptomatic benefit is likely within the first 72 hours.

Full Text

Cited Authors

  • Wiseman, R; Rowett, D; Allcroft, P; Abernethy, A; Currow, DC

Published Date

  • March 2013

Published In

Volume / Issue

  • 42 / 3

Start / End Page

  • 137 - 140

PubMed ID

  • 23529525

Pubmed Central ID

  • 23529525

International Standard Serial Number (ISSN)

  • 0300-8495


  • eng