Management

 

Reversible causes should be treated where possible

 

Pharmacological management:

According to the palliative care guideline the following treatment is recommended;

 

 Oxygen therapy may aid hypoxic patients i.e the O2 saturation is below 90%. Benefit versus adverse effects should be considered carefully prior to treatment because several factors is associated with such therapy and are listed below;

 

1. patients can  become psychologically dependent on this thus withdrawal can be difficult and cause anxiety.

2 the equipment is inconvenient to carry and mobility may be restricted.

3 Oxygen is drying on the mucosa and this causes other complications such as pain or infections

4 Risk of burns and fire hazard if patients are smokers

 

 

 Bronchodilators such as salbutamol can be administered via an inhaler or

spacer in patients with reversible airway obstruction (asthma). If it is not

producing any therapeutic effect then stop the drug.

Drugs include:

•  beta 2 agonists (salbutamol 2 puffs daily or 2.5-5mg as required via nebulizer)

• Ipratropium bromide is an antimuscarinic that dilates airways (250-500mcg 6 hourly nebulized or 2 puffs four times daily)

 

 

 Corticosteroids can be given in the morning, it may be beneficial in patients with oedema due to tumour or obsruction in the airways.

Drugs include:

• dexamethasone (4-8mg orally once daily)

If no effect is seen after 7 days, stop the drug or alternatively reduce gradually to

the lowest effective dose.