Dyspnoea management

 

Opioids:

Used correctly, opioids do not cause life threatening respiratory depression, instead the rate of respiration is reduced to an appropriate rate so efficient respiration can occur.

In opioid naive patients the initial dose should immediate release of oral morphine 2mg every 4-6 hours. This dose can be titrated upward at 30% interval if the patient tolerates the drug. If patients are unable to swallow, a subcutaneous formulation is available at 1-2mg given every 4 to 6 hours.

 

Alternatively diamorphine can be given subcutaneously at 1-2mg every 4 to 6hours. In geriatric patients, or those with renal impairment, the dose should be 1-2mg given every 6 to hourly.As with all drugs, monitoring for potential side effects is essential and opioids should be used with care as excessive dose can result in respiratory depression.  Patients already on opioids should be given 25% of the normal breakthrough dose every 4 hours. If dyspnoea persists, a long acting preparation of morphine can be given in addition to the equivalent 4 hourly immediate release morphine.

 

 

Benzodiazepines:

May help to alleviate anxiety but is less effective than opioids at relieving breathlessness, therefore it should only be given if opioids have not been successful or if patients experience anxiety. 

Drugs include: 

• Long acting preparations such as diazepam (2-5mg given at night when required or twice daily) are useful if dyspnoea interferes with quality of sleep or if it is severe.

• Shorter acting preparations such as lorazepam (0.5-2mg when required) or midazolam (2.5-5mg S/C or via buccal route) is useful in acute cases of dyspnoea.