Conditions such as pneumonia, COPD, asthma, effusions etc. should be dealt with using standard management. Seek further advice if needed.
For patients with SVC obstruction see Chapter: Palliative Care Emergencies.
For patients with stridor consider urgent referral to oncology or respiratory colleagues – high dose dexamethasone 16mg-40mg per day may be of benefit. For some patients however this may be part of a terminal process – see Section: Management of breathlessness in the dying phase.
Nebulised saline (sodium chloride 0.9%) may be of some benefit to patients to aid in the expectoration of secretions. Carbocisteine can also be used to reduce sputum viscosity (capsules or oral liquid – 750mg tds initially, reducing to 750mg bd once satisfactory response obtained).
Psychological factors (e.g. anxiety, fear of death from choking or suffocation) often exacerbate any breathlessness resulting from physical disease.
Occasionally breathlessness may be largely due to psychological factors.
In such circumstances, good palliation depends on exploring the patient’s beliefs about their breathlessness and their concerns. Reliance on pharmacological treatment alone will lead to unsatisfactory control of breathlessness.
Monitor for signs of CO2 retention e.g. drowsiness, tremor, new confusion
Bronchodilators – via inhaler +/- spacer or nebuliser. Stop if no benefit.
Steroids – especially if previous therapy has been beneficial e.g. for COPD.
Typical doses are:
Please also see also: Section: Management of breathlessness in the dying phase.
This Guide is intended for use by healthcare professionals and the expectation is that they will use clinical judgement, medical, and nursing knowledge in applying the general principles and recommendations contained within. They are not meant to replace the many available texts on the subject of palliative care.
Some of the management strategies describe the use of drugs outside their licensed indications. They are, however, established and accepted good practice. Please refer to the current BNF for further guidance.
While WMPCPS takes every care to compile accurate information , we cannot guarantee its correctness and completeness and it is subject to change. We do not accept responsibility for any loss, damage or expense resulting from the use of this information.