DYSPNEA MANAGEMENT IN PALLIATIVE CARE

Dyspnea Management in Palliative Care

Scope of the problem

The shortness of breath is considered to be one of the most common illnesses in myriad individuals. It is caused my various diseases and number of methods is formulated for the management of it but it still remains a very common problem. It affects the social and psychological life of an individual.

Introduction

The terms dyspnoea, breathlessness and shortness of breath are used interchangeably. Breathlessness remains a subjective sensation that cannot easily be quantified by a single measure. Objective measures such as respiratory rate, blood oxygen saturation

Breathlessness, or dyspnoea, remains a management challenge in symptom control, especially in advanced disease. At the end of life, poorly controlled dyspnoea can be distressing to patients, careers and health-care professionals. Traditionally, the use of certain drugs, particularly opioids, has been discouraged at it was considered that these may contribute to respiratory depression and hasten death. This article defines and determines the nature of breathlessness, discusses potentially reversible causes, explores mechanisms responsible for intractable breathlessness in advanced disease and details the management strategies commonly used for breathless patients.

Definition of breathlessness

Breathlessness is one of the most common symptoms in palliative care and can be present in advanced disease either from etiologies where breathlessness may be prominent throughout the course of the disease (such as chronic obstructive pulmonary disease or heart failure) or simply as a result of disease progression (notably cancer or neuromuscular disorders). Up to 70% of all cancer patients describe some form of symptomatic breathlessness in the last 6 weeks of life (Reuben and Mor, 1986). Dyspnoea has been defined by the American Thoracic Society (1999) as:

'A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that varies in intensity. The experience derives from interactions among multiple physiological, psychological, social, and environmental factors, and may induce secondary physiological and behavioral responses'.

Socio-cultural and Psychological Dimension

Dyspnoea or shortness of breath immensely affects the social and psychological life in a number of ways.

-Lack of confidence in myriad situations.

-A sense of pressure and stress.

-It inclines and individual to isolate from the mainstream.

-It can become a cause of various other diseases.

Pathophysiology

A number of effectors are involved in dyspnea resulting in a change of breathing:

Chemo-central receptors (acidosis)

Peripheral chemoreceptor carotid and aortic sensitive to hypoxia,

Thermo receptors upper airway

Bronchial or pulmonary mechanoreceptors (which are sensitive to opiates)

Mechanoreceptors muscle (diaphragm and chest muscles). Etiologies A number of cases are fairly easy to highlight (or even address):

Pneumonia (secondary infections or ulcers or esophageal- tracheal fistula)

Pleural or pericardial

Obstruction by enlarged lymph nodes, or metastatic lung tumor,

Lymphangitis

Carcinomatosis (including breast)

Anemia,

Heart problems (acute or subacute edema, pulmonary embolism)

Ascites,

Phrenic nerve palsy

Etiological treatment

Obstructions tumor warrant (when it is still possible chemotherapy or radiotherapy decompressive) Where there is a tracheal or bronchial obstruction isolated, laser treatment may help unclog a tumor (at least for a while). It may also propose the stenting.

Infectious pneumonia requires antibiotic therapy to the ...