Skip to main content

Advertisement

SpringerLink
Log in

The symptomatic relief of dyspnea

  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

Dyspnea is a common symptom that causes considerable suffering in cancer patients. Although some knowledge of the sensory information that is transduced to the brain during dyspnea exists, we still have only a rudimentary understanding of the subjective perception of this symptom. There appear to be many parallels between pain and dyspnea. Consistent with this fact, there is growing evidence that opioids are safe and effective and should be considered front-line therapy for symptomatic relief of dyspnea. In addition to opioids, there are other important pharmacologic and nonpharmacologic tools with varying degrees of support that can be considered for symptomatic relief. Importantly, because dyspnea is a subjective symptom that occurs in a unique individual, the optimal treatment of dyspnea will always entail an understanding of, and support for, a patient’s other sources of psychosocial, spiritual, and/or existential suffering.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med 1999, 159:321–340.

    Google Scholar 

  2. Reuben DB, Mor V: Dyspnea in terminally ill cancer patients. Chest 1986, 89:234–236.

    Article  PubMed  CAS  Google Scholar 

  3. Muers MF, Round CE: Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group. Thorax 1993, 48:339–343.

    PubMed  CAS  Google Scholar 

  4. Higginson I, McCarthy M: Measuring symptoms in terminal cancer: are pain and dyspnoea controlled? J R Soc Med 1989, 82:264–267.

    PubMed  CAS  Google Scholar 

  5. Banzett RB, Lansing RW, Reid MB, et al.: “Air hunger” arising from increased PCO2 in mechanically ventilated quadriplegics. Respir Physiol 1989, 76:53–67.

    Article  PubMed  CAS  Google Scholar 

  6. Lane R, Cockcroft A, Adams L, Guz A: Arterial oxygen saturation and breathlessness in patients with chronic obstructive airways disease. Clin Sci (Lond) 1987, 72:693–698.

    CAS  Google Scholar 

  7. Clark AL: Origin of symptoms in chronic heart failure. Heart 2006, 92:12–16.

    Article  PubMed  CAS  Google Scholar 

  8. Gaytan SP, Pasaro R: Connections of the rostral ventral respiratory neuronal cell group: an anterograde and retrograde tracing study in the rat. Brain Res Bull 1998, 47:625–642.

    Article  PubMed  CAS  Google Scholar 

  9. O’Donnell DE, Webb KA: Exertional breathlessness in patients with chronic airflow limitation. The role of lung hyperinflation. Am Rev Respir Dis 1993, 148:1351–1357.

    PubMed  CAS  Google Scholar 

  10. Manning HL, Molinary EJ, Leiter JC: Effect of inspiratory flow rate on respiratory sensation and pattern of breathing. Am J Respir Crit Care Med 1995, 151:751–757.

    PubMed  CAS  Google Scholar 

  11. Evans KC, Banzett RB, Adams L, et al.: BOLD fMRI identifies limbic, paralimbic, and cerebellar activation during air hunger. J Neurophysiol 2002, 88:1500–1511.

    PubMed  Google Scholar 

  12. Banzett RB, Mulnier HE, Murphy K, et al.: Breathlessness in humans activates insular cortex. Neuroreport 2000, 11:2117–2120.

    Article  PubMed  CAS  Google Scholar 

  13. Brannan S, Liotti M, Egan G, et al.: Neuroimaging of cerebral activations and deactivations associated with hypercapnia and hunger for air. Proc Natl Acad Sci U S A 2001, 98:2029–2034.

    Article  PubMed  CAS  Google Scholar 

  14. Liotti M, Brannan S, Egan G, et al.: Brain responses associated with consciousness of breathlessness (air hunger). Proc Natl Acad Sci U S A 2001, 98:2035–2040.

    Article  PubMed  CAS  Google Scholar 

  15. Parsons LM, Egan G, Liotti M, et al.: Neuroimaging evidence implicating cerebellum in the experience of hypercapnia and hunger for air. Proc Natl Acad Sci U S A 2001, 98:2041–2046.

    Article  PubMed  CAS  Google Scholar 

  16. Peiffer C, Poline JB, Thivard L, et al.: Neural substrates for the perception of acutely induced dyspnea. Am J Respir Crit Care Med 2001, 163:951–957.

    PubMed  CAS  Google Scholar 

  17. Baciu MV, Bonaz BL, Papillon E, et al.: Central processing of rectal pain: a functional MR imaging study. AJNR Am J Neuroradiol 1999, 20:1920–1924.

    PubMed  CAS  Google Scholar 

  18. Binkofski F, Schnitzler A, Enck P, et al.: Somatic and limbic cortex activation in esophageal distention: a functional magnetic resonance imaging study. Ann Neurol 1998, 44:811–815.

    Article  PubMed  CAS  Google Scholar 

  19. Derbyshire SW, Jones AK, Gyulai F, et al.: Pain processing during three levels of noxious stimulation produces differential patterns of central activity. Pain 1997, 73:431–445.

    Article  PubMed  CAS  Google Scholar 

  20. Iadarola MJ, Berman KF, Zeffiro TA, et al.: Neural activation during acute capsaicin-evoked pain and allodynia assessed with PET. Brain 1998, 121(Pt 5):931–947.

    Article  PubMed  Google Scholar 

  21. Peyron R, Garcia-Larrea L, Gregoire MC, et al.: Haemodynamic brain responses to acute pain in humans: sensory and attentional networks. Brain 1999, 122(Pt 9):1765–1780.

    Article  PubMed  Google Scholar 

  22. Denton D, Shade R, Zamarippa F, et al.: 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 1999, 96:2532–2537.

    Article  PubMed  CAS  Google Scholar 

  23. Tataranni PA, Gautier JF, Chen K, et al.: Neuroanatomical correlates of hunger and satiation in humans using positron emission tomography. Proc Natl Acad Sci U S A 1999, 96:4569–4574.

    Article  PubMed  CAS  Google Scholar 

  24. von Leupoldt A, Mertz C, Kegat S, et al.: The impact of emotions on the sensory and affective dimension of perceived dyspnea. Psychophysiology 2006, 43:382–386.

    Article  Google Scholar 

  25. Rainville P, Bao QV, Chretien P: Pain-related emotions modulate experimental pain perception and autonomic responses. Pain 2005, 118:306–318.

    Article  PubMed  Google Scholar 

  26. Villemure C, Bushnell MC: Cognitive modulation of pain: how do attention and emotion influence pain processing? Pain 2002, 95:195–199.

    Article  PubMed  Google Scholar 

  27. Gracely RH, Undem BJ, Banzett RB: Cough, pain and dyspnoea: similarities and differences. Pulm Pharmacol Ther 2007, 20:433–437.

    Article  PubMed  CAS  Google Scholar 

  28. Le Bars D, Dickenson AH, Besson JM: Diffuse noxious inhibitory controls (DNIC). I. Effects on dorsal horn convergent neurones in the rat. Pain 1979, 6:283–304.

    Article  PubMed  Google Scholar 

  29. Le Bars D, Dickenson AH, Besson JM: Diffuse noxious inhibitory controls (DNIC). II. Lack of effect on non-convergent neurones, supraspinal involvement and theoretical implications. Pain 1979, 6:305–327.

    Article  PubMed  Google Scholar 

  30. Skljarevski V, Ramadan NM: The nociceptive flexion reflex in humans: review article. Pain 2002, 96:3–8.

    Article  PubMed  CAS  Google Scholar 

  31. Morelot-Panzini C, Demoule A, Straus C, et al.: Dyspnea as a noxious sensation: inspiratory threshold loading may trigger diffuse noxious inhibitory controls in humans. J Neurophysiol 2007, 97:1396–1404.

    Article  PubMed  Google Scholar 

  32. Akiyama Y, Nishimura M, Kobayashi S, et al.: Effects of naloxone on the sensation of dyspnea during acute respiratory stress in normal adults. J Appl Physiol 1993, 74:590–595.

    PubMed  CAS  Google Scholar 

  33. Zebraski SE, Kochenash SM, Raffa RB: Lung opioid receptors: pharmacology and possible target for nebulized morphine in dyspnea. Life Sci 2000, 66:2221–2231.

    Article  PubMed  CAS  Google Scholar 

  34. Bruera E, MacEachern T, Ripamonti C, Hanson J: Subcutaneous morphine for dyspnea in cancer patients. Ann Intern Med 1993, 119:906–907.

    PubMed  CAS  Google Scholar 

  35. Chua TP, Harrington D, Ponikowski P, et al.: Effects of dihydrocodeine on chemosensitivity and exercise tolerance in patients with chronic heart failure. J Am Coll Cardiol 1997, 29:147–152.

    Article  PubMed  CAS  Google Scholar 

  36. Williams SG, Wright DJ, Marshall P, et al.: Safety and potential benefits of low dose diamorphine during exercise in patients with chronic heart failure. Heart 2003, 89:1085–1086.

    Article  PubMed  CAS  Google Scholar 

  37. Johnson MJ, McDonagh TA, Harkness A, et al.: Morphine for the relief of breathlessness in patients with chronic heart failure: a pilot study. Eur J Heart Fail 2002, 4:753–756.

    Article  PubMed  CAS  Google Scholar 

  38. Light RW, Muro JR, Sato RI, et al.: Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1989, 139:126–133.

    PubMed  CAS  Google Scholar 

  39. Abernethy AP, Currow DC, Frith P, et al.: Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ 2003, 327:523–528.

    Article  PubMed  CAS  Google Scholar 

  40. Jennings AL, Davies AN, Higgins JP, et al.: A systematic review of the use of opioids in the management of dyspnoea. Thorax 2002, 57:939–944.

    Article  PubMed  Google Scholar 

  41. Mazzocato C, Buclin T, Rapin CH: The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol 1999, 10:1511–1514.

    Article  PubMed  CAS  Google Scholar 

  42. Allard P, Lamontagne C, Bernard P, Tremblay C: How effective are supplementary doses of opioids for dyspnea in terminally ill cancer patients? A randomized continuous sequential clinical trial. J Pain Symptom Manage 1999, 17:256–265.

    Article  PubMed  CAS  Google Scholar 

  43. Schwartzstein RM, Lahive K, Pope A, et al.: Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis 1987, 136:58–61.

    PubMed  CAS  Google Scholar 

  44. Liss HP, Grant BJ: The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 1988, 137:1285–1288.

    PubMed  CAS  Google Scholar 

  45. Burgess KR, Whitelaw WA: Effects of nasal cold receptors on pattern of breathing. J Appl Physiol 1988, 64:371–376.

    Article  PubMed  CAS  Google Scholar 

  46. Philip J, Gold M, Milner A, et al.: A randomized, double-blind, crossover trial of the effect of oxygen on dyspnea in patients with advanced cancer. J Pain Symptom Manage 2006, 32:541–550.

    Article  PubMed  CAS  Google Scholar 

  47. Bruera E, Sweeney C, Willey J, et al.: A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea. Palliat Med 2003, 17:659–663.

    PubMed  Google Scholar 

  48. Mitchell-Heggs P, Murphy K, Minty K, et al.: Diazepam in the treatment of dyspnoea in the “Pink Puffer” syndrome. Q J Med 1980, 49:9–20.

    PubMed  CAS  Google Scholar 

  49. Stark RD, Gambles SA, Lewis JA: 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) 1981, 61:429–439.

    CAS  Google Scholar 

  50. Woodcock AA, Gross ER, Geddes DM: Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers. Br Med J (Clin Res Ed) 1981, 283:343–346.

    Article  CAS  Google Scholar 

  51. Man GC, Hsu K, Sproule BJ: Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest 1986, 90:832–836.

    Article  PubMed  CAS  Google Scholar 

  52. Dudgeon DJ, Lertzman M: Dyspnea in the advanced cancer patient. J Pain Symptom Manage 1998, 16:212–219.

    Article  PubMed  CAS  Google Scholar 

  53. Navigante AH, Cerchietti LC, Castro MA, et al.: Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage 2006, 31:38–47.

    Article  PubMed  CAS  Google Scholar 

  54. O’Neill PA, Morton PB, Stark RD: Chlorpromazine: a specific effect on breathlessness? Br J Clin Pharmacol 1985, 19:793–797.

    PubMed  CAS  Google Scholar 

  55. Shimoyama N, Shimoyama M: Nebulized furosemide as a novel treatment for dyspnea in terminal cancer patients. J Pain Symptom Manage 2002, 23:73–76.

    Article  PubMed  CAS  Google Scholar 

  56. Nishino T, Ide T, Sudo T, Sato J: Inhaled furosemide greatly alleviates the sensation of experimentally induced dyspnea. Am J Respir Crit Care Med 2000, 161:1963–1967.

    PubMed  CAS  Google Scholar 

  57. Minowa Y, Ide T, Nishino T: Effects of inhaled furosemide on CO(2) ventilatory responsiveness in humans. Pulm Pharmacol Ther 2002, 15:363–368.

    Article  PubMed  CAS  Google Scholar 

  58. Moosavi SH, Binks AP, Lansing RW, et al.: Effect of inhaled furosemide on air hunger induced in healthy humans. Respir Physiol Neurobiol 2007, 156:1–8.

    Article  PubMed  CAS  Google Scholar 

  59. Ong KC, Kor AC, Chong WF, et al.: Effects of inhaled furosemide on exertional dyspnea in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2004, 169:1028–1033.

    Article  PubMed  Google Scholar 

  60. Sudo T, Hayashi F, Nishino T: Responses of tracheobronchial receptors to inhaled furosemide in anesthetized rats. Am J Respir Crit Care Med 2000, 162:971–975.

    PubMed  CAS  Google Scholar 

  61. Taguchi O, Kikuchi Y, Hida W, et al.: Effects of bronchoconstriction and external resistive loading on the sensation of dyspnea. J Appl Physiol 1991, 71:2183–2190.

    PubMed  CAS  Google Scholar 

  62. Winning AJ, Hamilton RD, Guz A: Ventilation and breathlessness on maximal exercise in patients with interstitial lung disease after local anaesthetic aerosol inhalation. Clin Sci (Lond) 1988, 74:275–281.

    CAS  Google Scholar 

  63. Wilcock A, Corcoran R, Tattersfield AE: Safety and efficacy of nebulized lignocaine in patients with cancer and breathlessness. Palliat Med 1994, 8:35–38.

    Article  PubMed  CAS  Google Scholar 

  64. Jobst K, Chen JH, McPherson K, et al.: Controlled trial of acupuncture for disabling breathlessness. Lancet 1986, 2:1416–1419.

    Article  PubMed  CAS  Google Scholar 

  65. Lewith GT, Prescott P, Davis CL: Can a standardized acupuncture technique palliate disabling breathlessness: a single-blind, placebo-controlled crossover study. Chest 2004, 125:1783–1790.

    Article  PubMed  Google Scholar 

  66. Bredin M, Corner J, Krishnasamy M, et al.: Multicentre randomised controlled trial of nursing intervention for breathlessness in patients with lung cancer. BMJ 1999, 318:901–904.

    PubMed  CAS  Google Scholar 

  67. Booth S, Farquhar M, Gysels M, et al.: The impact of a breathlessness intervention service (BIS) on the lives of patients with intractable dyspnea: a qualitative phase 1 study. Palliat Support Care 2006, 4:287–293.

    Article  PubMed  Google Scholar 

  68. Nield MA, Soo Hoo GW, Roper JM, Santiago S: Efficacy of pursed-lips breathing: a breathing pattern retraining strategy for dyspnea reduction. J Cardiopulm Rehabil Prev 2007, 27:237–244.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. San Diego Hospice and Palliative Medicine, 4311 Third Avenue, San Diego, CA, 92103, USA

    Jay Thomas

Authors
  1. Giovanni Elia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jay Thomas
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jay Thomas.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Elia, G., Thomas, J. The symptomatic relief of dyspnea. Curr Oncol Rep 10, 319–325 (2008). https://doi.org/10.1007/s11912-008-0050-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11912-008-0050-7

Keywords

Search

Navigation