Skip to main content
SpringerLink
Log in

Management of Dyspnea

  • Chapter
  • First Online:
Supportive Care in Cancer Therapy

Part of the book series: Cancer Drug Discovery and Development ((CDD&D))

  • 1094 Accesses

Abstract

Unfortunately, dyspnea is a common symptom in supportive care and the source of much suffering. As we understand more about the pathophysiology of dyspnea, we can better assess it, reverse its root causes when possible, and symptomatically treat it when reversal is not possible. This chapter focuses predominantly on the symptomatic relief of dyspnea. Because all interventions have benefits and burdens, any particular intervention must be assessed in the context of a patient’s goals of care. Although invasive and pharmacologic interventions can be useful in many patients, because dyspnea is a subjective phenomenon, psychosocial/spiritual support is needed in all patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Emanuel EJ, Fairclough DL, Slutsman J, Emanuel LL. 2000; Understanding economic and other burdens of terminal illness: the experience of patients and their caregivers. Ann Intern Med 132:(6)451–9.

    PubMed  CAS  Google Scholar 

  2. Muers MF, Round CE. 1993; Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group. Thorax 48:(4)339–43.

    Article  PubMed  CAS  Google Scholar 

  3. Higginson I, McCarthy M. 1989; Measuring symptoms in terminal cancer: are pain and dyspnoea controlled? J R Soc Med 82:(5)264–7.

    PubMed  CAS  Google Scholar 

  4. Reuben DB, Mor V. 1986; Dyspnea in terminally ill cancer patients. Chest 89:(2)234–6.

    Article  PubMed  CAS  Google Scholar 

  5. Manning HL, Schwartzstein RM. 1995; Pathophysiology of dyspnea. N Engl J Med 333:(23)1547–53.

    Article  PubMed  CAS  Google Scholar 

  6. Dyspnea. 1999; Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med 159:(1)321–40.

    Google Scholar 

  7. Banzett RB, Lansing RW, Reid MB, Adams L, Brown R. 1989; ‘Air hunger’ arising from increased PCO2 in mechanically ventilated quadriplegics. Respir Physiol 76:(1)53–67.

    Article  PubMed  CAS  Google Scholar 

  8. Lane R, Cockcroft A, Adams L, Guz A. 1987; Arterial oxygen saturation and breathlessness in patients with chronic obstructive airways disease. Clin Sci (Lond) 72:(6)693–8.

    CAS  Google Scholar 

  9. Eyzaguirre C, Zapata P. 1984; Perspectives in carotid body research. J Appl Physiol 57:(4)931–57.

    PubMed  CAS  Google Scholar 

  10. Taguchi O, Kikuchi Y, Hida W,. et al. 1991; Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea. J Appl Physiol 71:(6)2183–90.

    PubMed  CAS  Google Scholar 

  11. O’Donnell DE, Webb KA. 1993; Exertional breathlessness in patients with chronic airflow limitation. The role of lung hyperinflation. Am Rev Respir Dis 148:(5)1351–7.

    PubMed  Google Scholar 

  12. Manning HL, Molinary EJ, Leiter JC. 1995; Effect of inspiratory flow rate on respiratory sensation and pattern of breathing. Am J Respir Crit Care Med 151:(3 Pt 1)751–7.

    PubMed  CAS  Google Scholar 

  13. Dudgeon DJ, Lertzman M. 1998; Dyspnea in the advanced cancer patient. J Pain Symptom Manage 16:(4)212–19.

    Article  PubMed  CAS  Google Scholar 

  14. Simon PM, Schwartzstein RM, Weiss JW, Fencl V, Teghtsoonian M, Weinberger SE. 1990; Distinguishable types of dyspnea in patients with shortness of breath. Am Rev Respir Dis 142:(5)1009–14.

    PubMed  CAS  Google Scholar 

  15. Binks AP, Moosavi SH, Banzett RB, Schwartzstein RM. 2002; “Tightness” sensation of asthma does not arise from the work of breathing. Am J Respir Crit Care Med 165:(1)78–82.

    PubMed  Google Scholar 

  16. Evans KC, Banzett RB, Adams L, McKay L, Frackowiak RS, Corfield DR. 2002; BOLD fMRI identifies limbic, paralimbic, and cerebellar activation during air hunger. J Neurophysiol 88:(3)1500–11.

    PubMed  Google Scholar 

  17. Banzett RB, Mulnier HE, Murphy K, Rosen SD, Wise RJ, Adams L. 2000; Breathlessness in humans activates insular cortex. Neuroreport 11:(10)2117–20.

    Article  PubMed  CAS  Google Scholar 

  18. Brannan S, Liotti M, Egan G,. et al. 2001; Neuroimaging of cerebral activations and deactivations associated with hypercapnia and hunger for air. Proc Natl Acad Sci U S A 98:(4)2029–34.

    Article  PubMed  CAS  Google Scholar 

  19. Liotti M, Brannan S, Egan G,. et al. 2001; Brain responses associated with consciousness of breathlessness (air hunger). Proc Natl Acad Sci U S A 98:(4)2035–40.

    Article  PubMed  CAS  Google Scholar 

  20. Parsons LM, Egan G, Liotti M,. et al. 2001; Neuroimaging evidence implicating cerebellum in the experience of hypercapnia and hunger for air. Proc Natl Acad Sci U S A 98:(4)2041–6.

    Article  PubMed  CAS  Google Scholar 

  21. Peiffer C, Poline JB, Thivard L, Aubier M, Samson Y. 2001; Neural substrates for the perception of acutely induced dyspnea. Am J Respir Crit Care Med 163:(4)951–7.

    PubMed  CAS  Google Scholar 

  22. Gaytan SP, Pasaro R. 1998; Connections of the rostral ventral respiratory neuronal cell group: an anterograde and retrograde tracing study in the rat. Brain Res Bull 47:(6)625–42.

    Article  PubMed  CAS  Google Scholar 

  23. Baciu MV, Bonaz BL, Papillon E,. et al. 1999; Central processing of rectal pain: a functional MR imaging study. AJNR Am J Neuroradiol 20:(10)1920–4.

    PubMed  CAS  Google Scholar 

  24. Binkofski F, Schnitzler A, Enck P,. et al. 1998; Somatic and limbic cortex activation in esophageal distention: a functional magnetic resonance imaging study. Ann Neurol 44:(5)811–15.

    Article  PubMed  CAS  Google Scholar 

  25. Derbyshire SW, Jones AK, Gyulai F, Clark S, Townsend D, Firestone LL. 1997; Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain 73:(3)431–45.

    Article  PubMed  CAS  Google Scholar 

  26. Iadarola MJ, Berman KF, Zeffiro TA,. et al. 1998; Neural activation during acute capsaicin-evoked pain and allodynia assessed with PET. Brain 121:(Pt 5)931–47.

    Article  PubMed  Google Scholar 

  27. Peyron R, Garcia-Larrea L, Gregoire MC,. et al. 1999; Haemodynamic brain responses to acute pain in humans: sensory and attentional networks. Brain 122:(Pt 9)1765–80.

    Article  PubMed  Google Scholar 

  28. Denton D, Shade R, Zamarippa F,. et al. 1999; Correlation of regional cerebral blood flow and change of plasma sodium concentration during genesis and satiation of thirst. Proc Natl Acad Sci U S A 96:(5)2532–7.

    Article  PubMed  CAS  Google Scholar 

  29. Tataranni PA, Gautier JF, Chen K,. et al. 1999; Neuroanatomical correlates of hunger and satiation in humans using positron emission tomography. Proc Natl Acad Sci U S A 96:(8)4569–74.

    Article  PubMed  CAS  Google Scholar 

  30. Adams L, Chronos N, Lane R, Guz A. 1985; The measurement of breathlessness induced in normal subjects: validity of two scaling techniques. Clin Sci (Lond) 69:(1)7–16.

    CAS  Google Scholar 

  31. Borg GA. 1982; Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:(5)377–81.

    PubMed  CAS  Google Scholar 

  32. Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Weiss JW. 1987; Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis 136:(1)58–61.

    Article  PubMed  CAS  Google Scholar 

  33. Liss HP, Grant BJ. 1988; The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 137:(6)1285–8.

    PubMed  CAS  Google Scholar 

  34. Burgess KR, Whitelaw WA. 1988; Effects of nasal cold receptors on pattern of breathing. J Appl Physiol 64:(1)371–6.

    Article  PubMed  CAS  Google Scholar 

  35. Mitchell-Heggs P, Murphy K, Minty K,. et al. 1980; Diazepam in the treatment of dyspnoea in the ‘Pink Puffer’ syndrome. Q J Med 49:(193)9–20.

    PubMed  CAS  Google Scholar 

  36. Stark RD, Gambles SA, Lewis JA. 1981; Methods to assess breathlessness in healthy subjects: a critical evaluation and application to analyse the acute effects of diazepam and promethazine on breathlessness induced by exercise or by exposure to raised levels of carbon dioxide. Clin Sci (Lond) 61:(4)429–39.

    CAS  Google Scholar 

  37. Woodcock AA, Gross ER, Geddes DM. 1981; Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers. Br Med J (Clin Res Ed) 283:(6287)343–6.

    Article  CAS  Google Scholar 

  38. Man GC, Hsu K, Sproule BJ. 1986; Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest 90:(6)832–6.

    Article  PubMed  CAS  Google Scholar 

  39. Navigante AH, Cerchietti LC, Castro MA, Lutteral MA, Cabalar ME. 2006; Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage 31:(1)38–47.

    Article  PubMed  CAS  Google Scholar 

  40. Argyropoulou P, Patakas D, Koukou A, Vasiliadis P, Georgopoulos D. 1993; Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease. Respiration 60:(4)216–20.

    Article  PubMed  CAS  Google Scholar 

  41. Singh NP, Despars JA, Stansbury DW, Avalos K, Light RW. 1993; Effects of buspirone on anxiety levels and exercise tolerance in patients with chronic airflow obstruction and mild anxiety. Chest 103:(3)800–4.

    Article  PubMed  CAS  Google Scholar 

  42. O’Neill PA, Morton PB, Stark RD. 1985; Chlorpromazine -- a specific effect on breathlessness? Br J Clin Pharmacol 19:(6)793–7.

    PubMed  Google Scholar 

  43. Zebraski SE, Kochenash SM, Raffa RB. 2000; Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea. Life Sci 66:(23)2221–31.

    Article  PubMed  CAS  Google Scholar 

  44. Akiyama Y, Nishimura M, Kobayashi S,. et al. 1993; Effects of naloxone on the sensation of dyspnea during acute respiratory stress in normal adults. J Appl Physiol 74:(2)590–5.

    PubMed  CAS  Google Scholar 

  45. Bruera E, MacEachern T, Ripamonti C, Hanson J. 1993; Subcutaneous morphine for dyspnea in cancer patients. Ann Intern Med 119:(9)906–7.

    PubMed  CAS  Google Scholar 

  46. Mazzocato C, Buclin T, Rapin CH. 1999; The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol 10:(12)1511–14.

    Article  PubMed  CAS  Google Scholar 

  47. Allard P, Lamontagne C, Bernard P, Tremblay C. 1999; How effective are supplementary doses of opioids for dyspnea in terminally ill cancer patients? A randomized continuous sequential clinical trial. J Pain Symptom Manage 17:(4)256–65.

    Article  PubMed  CAS  Google Scholar 

  48. Chua TP, Harrington D, Ponikowski P, Webb-Peploe K, Poole-Wilson PA, Coats AJ. 1997; Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol 29:(1)147–52.

    Article  PubMed  CAS  Google Scholar 

  49. Williams SG, Wright DJ, Marshall P,. et al. 2003; Safety and potential benefits of low dose diamorphine during exercise in patients with chronic heart failure. Heart 89:(9)1085–6.

    Article  PubMed  CAS  Google Scholar 

  50. Johnson MJ, McDonagh TA, Harkness A, McKay SE, Dargie HJ. 2002; Morphine for the relief of breathlessness in patients with chronic heart failure – a pilot study. Eur J Heart Fail 4:(6)753–6.

    Article  PubMed  CAS  Google Scholar 

  51. Light RW, Muro JR, Sato RI, Stansbury DW, Fischer CE, Brown SE. 1989; Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 139:(1)126–33.

    Article  PubMed  CAS  Google Scholar 

  52. Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C. 2003; Randomised, double blind, placebo-controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ 327:(7414)523–8.

    Article  PubMed  CAS  Google Scholar 

  53. Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE. 2002; A systematic review of the use of opioids in the management of dyspnoea. Thorax 57:(11)939–44.

    Article  PubMed  Google Scholar 

  54. Winning AJ, Hamilton RD, Guz A. 1988; Ventilation and breathlessness on maximal exercise in patients with interstitial lung disease after local anaesthetic aerosol inhalation. Clin Sci (Lond) 74:(3)275–81.

    CAS  Google Scholar 

  55. Wilcock A, Corcoran R, Tattersfield AE. 1994; Safety and efficacy of nebulized lignocaine in patients with cancer and breathlessness. Palliat Med 8:(1)35–8.

    Article  PubMed  CAS  Google Scholar 

  56. Stone P, Kurowska A, Tookman A. 1994; Nebulized frusemide for dyspnoea. Palliat Med 8:(3)258.

    Article  PubMed  CAS  Google Scholar 

  57. Shimoyama N, Shimoyama M. 2002; Nebulized furosemide as a novel treatment for dyspnea in terminal cancer patients. J Pain Symptom Manage 23:(1)73–6.

    Article  PubMed  CAS  Google Scholar 

  58. Sudo T, Hayashi F, Nishino T. 2000; Responses of tracheobronchial receptors to inhaled furosemide in anesthetized rats. Am J Respir Crit Care Med 162:(3 Pt 1)971–5.

    PubMed  CAS  Google Scholar 

  59. Manning HL, Shea SA, Schwartzstein RM, Lansing RW, Brown R, Banzett RB. 1992; Reduced tidal volume increases ‘air hunger’ at fixed PCO2 in ventilated quadriplegics. Respir Physiol 90:(1)19–30.

    Article  PubMed  CAS  Google Scholar 

  60. Nishino T, Ide T, Sudo T, Sato J. 2000; Inhaled furosemide greatly alleviates the sensation of experimentally induced dyspnea. Am J Respir Crit Care Med 161:(6)1963–7.

    PubMed  CAS  Google Scholar 

  61. Moosavi SH, Binks AP, Lansing RW, Topulos GP, Banzett RB, Schwartzstein RM. 2007; Effect of inhaled furosemide on air hunger induced in healthy humans. Respir Physiol Neurobiol 156:(1)1–8.

    Article  PubMed  CAS  Google Scholar 

  62. Bredin M, Corner J, Krishnasamy M, Plant H, Bailey C, A’Hern R. 1999; Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. BMJ 318:(7188)901–4.

    Article  PubMed  CAS  Google Scholar 

  63. Pulmonary rehabilitation-1999. 1999; American Thoracic Society. Am J Respir Crit Care Med 159:(5 Pt 1)1666–82.

    Google Scholar 

  64. Pan CX, Morrison RS, Ness J, Fugh-Berman A, Leipzig RM. 2000; Complementary and alternative medicine in the management of pain, dyspnea, and nausea and vomiting near the end of life. A systematic review. J Pain Symptom Manage 20:(5)374–87.

    Article  PubMed  CAS  Google Scholar 

  65. Jobst K, Chen JH, McPherson K,. et al. 1986; Controlled trial of acupuncture for disabling breathlessness. Lancet 2:(8521–2)1416–19.

    Article  PubMed  CAS  Google Scholar 

  66. Maa SH, Gauthier D, Turner M. 1997; Acupressure as an adjunct to a pulmonary rehabilitation program. J Cardiopulm Rehabil 17:(4)268–76.

    Article  PubMed  CAS  Google Scholar 

  67. Voltz R, Borasio GD. 1997; Palliative therapy in the terminal stage of neurological disease. J Neurol 244:(Suppl 4)S2–10.

    Article  PubMed  Google Scholar 

  68. Borasio GD, Voltz R. 1997; Palliative care in amyotrophic lateral sclerosis. J Neurol 244:(Suppl 4)S11–17.

    Article  PubMed  Google Scholar 

  69. Polkey MI, Lyall RA, Davidson AC, Leigh PN, Moxham J. 1999; Ethical and clinical issues in the use of home non-invasive mechanical ventilation for the palliation of breathlessness in motor neurone disease. Thorax 54:(4)367–71.

    Article  PubMed  CAS  Google Scholar 

  70. Lightowler JV, Wedzicha JA, Elliott MW, Ram FS. 2003; Non-invasive positive pressure ventilation to treat respiratory failure resulting from exacerbations of chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. BMJ 326:(7382)185.

    Article  PubMed  Google Scholar 

  71. Nava S, Cuomo AM. 2004; Acute respiratory failure in the cancer patient: the role of non-invasive mechanical ventilation. Crit Rev Oncol Hematol 51:(2)91–103.

    Article  PubMed  Google Scholar 

  72. Fainsinger RL, Waller A, Bercovici M,. et al. 2000; A multicentre international study of sedation for uncontrolled symptoms in terminally ill patients. Palliat Med 14:(4)257–65.

    Article  PubMed  CAS  Google Scholar 

  73. Sykes N, Thorns A. 2003; Sedative use in the last week of life and the implications for end-of-life decision making. Arch Intern Med 163:(3)341–4.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chair, Department of Supportive Care Medicine City of Hope National Medical Center Northwest Bldg, Rm 1218 1500 East Duarte Rd., Duarte, CA, 91010, USA

    Jay R. Thomas

Authors
  1. Jay R. Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jay R. Thomas .

Editor information

Editors and Affiliations

  1. Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    David S. Ettinger

Rights and permissions

Reprints and permissions

Copyright information

© 2009 Humana Press, a part of Springer Science + Business Media, LLC

About this chapter

Cite this chapter

Thomas , J. (2009). Management of Dyspnea. In: Ettinger, D.S. (eds) Supportive Care in Cancer Therapy. Cancer Drug Discovery and Development. Humana Press. https://doi.org/10.1007/978-1-59745-291-5_1

Download citation

  • DOI: https://doi.org/10.1007/978-1-59745-291-5_1

  • Published:

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-941-3

  • Online ISBN: 978-1-59745-291-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation