Overview

Overview

Dyspnea is a common and distressing symptom at the end-of-life in patients with cancer and non-cancer diagnoses and is associated with decreased functionality and poor quality of life.

Definition

The word dyspnea comes the Greek “dys-“, difficulty + “pnoia”, breathing = difficulty breathing.

The American Thoracic Society (ATS) defines dyspnea as “a term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.”

(American Thoracic Society 1999)

Normal Breathing vs. Dyspneic Breathing

Breathing is a special vital function in that it is involuntary but can be partially controlled voluntarily for a short duration. You can control your breath rate for a short spell, but you cannot make your heart beat faster at will.

Prevalence

 

Dyspnea prevalence of 49.1% in a general cancer population (Dudgeon 2001)

Breathlessness was a complaint at presentation in 60%, and nearly 90% just prior to death, in a cohort of patients with lung cancer (Muers 1993)

Of the patient population with non-cancer terminal illness, dyspnea is a very problematic symptom in patients with end-stage lung disease (both in obstructive and restrictive lung diseases) and in patients with advanced congestive heart failure.

Consequences

 

Shortness of breath may be of more consequence to dying patients than even pain (Institute of Medicine 1997) (Weiss 2001) (Portenoy 1994).

Dyspnea is associated with decreased quality of life and increased bio-psycho-socio-spiritual distress in patients with advanced illness.

Causes

Dyspnea is often caused by complex interactions between physiological, psychological, social, and environmental factors, and may result in secondary physiological and behavioral responses (American Thoracic Society 1999).

Assessment

Assessing the triggers, intensity, and quality of breathlessness determine treatment options (Portenoy 1994).

Treatment

Treatment goal for dyspnea in palliative care setting is to improve the patient’s quality of life as much as possible until a comfortable death occurs. Treatment options are:

  • Environmental
  • Psychosocial and Interpersonal
  • Rehabilitative
  • Pharmacological
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