Pharmacological Managment of dyspnea
Optimum treatment of dyspnea is treatment of reversible causes, if the patient`s condition is not reversable then treat with both nonpharmacological and pharmacological methods.
- Sit the patient upright with the use of pillows or have them lean over the overbed table
- delivery oxygen
- use relaxation techniques and other appropriate nonpharmacological measures
- identify and treat the underlying cause of the dyspnea
- complement with phenothiazine (chlorpromazine, promethazine)
- complement with anxiolytic
Opioids have been used since the late 19th century to relieve breathlessness associated with asthma, pneumothorax and emphysema. Opioids are also used in the treatment of dyspnea that occurs in cancer patients.
More recently, nebulizers have been used to for the treatment of dyspnea. opioid receptors are present on the sensory nerve endings of the lungs. Binding these sensory recepetors directly allows for more rapid symptom relief, lower medication doses to be used and resultantly fewer side effect experienced by the patient.
A note on opioids and respiratory depression is warrented here; The development of clincially significant hypoventilation and respiratory depression from opioids is dependent on the following:
- the rate of dose change.
- history of previous opioid exposure, or opioid tolerance
- and the route of administration with respect to amount and speed of absorption
Early use of opioid improves quality of life. Routine dosing allows for smaller doses to be given, providing the desired symptom relief as the tolerance to respiratory depressive effects develop. In doing so, prolongs rather than hastens the death of a patient while reducing physical and psychological distress and exhaustion associated with dyspnea.
Sedetives and Tranquilizers
Chlorpromazine is effective in reducing dyspnea and improving exercise tolerance.
Combinations of morphine and promethazine have also been shown effective in treating dyspnea and have also been shown to improve exercise tolerance without worsening dyspnea.
Routine q4h morphine with breakthrough medazolam or routine medazolam with breakthrough morphine both showed significant reduction in dyspnea within 24hrs.
Preliminary studies have shown that nebulized furosemide has positive effects in the management of dyspnea in patients suffering from asthma, COPD and cancer.
Ferrel, B. R., & Coyle, N. (Eds.). (2010). Oxford textbook of palliative nursing (3rd ed.). New York: Oxford University Press. p. 307