Dyspnoea

 

This is one of the symptoms feared by patients and families and therefore it is important to resolve anxiety and provide effective management of this symptom.

 

Treatment:

 

Pharmacological therapy: This includes oxygen therapy (even if not hypoxic), opioid,

benzodiaxepines, hyoscine and nebulised saline.

 

Oxygen therapy

Although it does not correct the cause of hypoxia, this form of therapy provides reassurance to patients and families which may be beneficial in reducing fear. Oxygen can be administered via nasal cannula or

face mask, however the latter may cause discomfort and considered by some to be intrusive in this period. In addition, administration of nebulised saline (0.9%) aid dispersion of retained secretion to ease breathing.

 

Opioid

In patients who are able to swallow, oral morphine (15-30mg) is administered 4 hourly (or 2.5mg if opioid naive). Subcutaneous diamorphine is available if unable to utilise the oral route (5-10mg every 24 hours), however if morphine is already taken for the relief of pain this will require a  dose reduction by 30-50%. 

 

 Benzodiazepines

Oral diazepam is initially started at 2 mg and if it is tolerated then it can be titrated up to 2-5mg. If unable to take by mouth, lorazepam 0.5-1mg can be given as required.

 

Hyoscine

This is an antisecretory indicated in noisy breathing due to pooled secretions. The recommended dose in hyoscine butuylbromide is 20mg via subcutaneous bolus (up to 120mg every 24 hours). Alternatively, hyoscine hydrobromide is available at 0.4 to 0.6mg up to 2.4mg every 24 hours.