Nonpharmacologic Management of Dyspnea

Oxygen

The administration of oxygen either on an as needed or continuous basis has been shown to improve exercise tolerance, neuropsychological performance and not surprisingly, survival in patients with chronic end stage disease (Ferrell & Coyle, 2010, p. 308).

Positional changes

sitting upright, reclining semi-Fowler’s or leaning forward and supporting the torso on an overbed table can be highly effective at easing breathing (Ferrell & Coyle, 2010, p. 308). If a patient is not mobilizing well and spending much of their time in a chair or in bed, positioning strongly influences their level of comfort. Positions that alleviate abdominal compression or open the chest cavity quickly ease breathing (Downing and Wainwright, 2006, p. 370). Positional changes are effective by acting to increase the length-tension state of the diaphragm, increasing its oxygen intake efficiency (Ferrell & Coyle, 2010, p. 308). Supportive aids such as pillows or mechanical bed elevations of the knees or behind the back can also help further open air ways and ease of respiration.

Pursed lipped breathing.

This can be performed anywhere, at any time, and is easily taught to patients. Purse-lipped breathing is effective through slowing the respiratory rate down while simultaneously increasing the airway pressure. This dual action maintains the smaller air passages, facilitating greater oxygen delivery during times of severe dyspnea (Ferrell & Coyle, 2010, p. 309).

cold air directed against a cheek from an open window breeze or that of a fan.

It has been observed that the flow of cold air across the nose or cheek slows ventilation and relieves the sensation of breathlessness. Cold-air triggered ventilation changes exert their effect through stimulation of the trigeminal nerve pathway by a combination of the thermal and motion stimuli (Ferrell & Coyle, 2010, p. 308). A cool breeze directed towards the patient’s face may also lessen their sensation of breathlessness through physiologic stimulation of the fifth cranial triggering a central inhibitory effect of the sensed dyspnea (Indelicato, 2006, p. 6).

A cool breeze can be very effective in decreasing anxiety, so can the patients environment. A cool, humidified room may trigger some of the same dyspnea-sensation relieving neural pathways as the cool breeze. Very dry air is an exacerbating factor for any respiratory condition, and the addition of a humidifier to the patient’s environment can quickly eliminate this (Downing and Wainwright, 2006, p. 370).

Ensuring the patient’s social environment is not exacerbating their sensation of breathlessness is foundational. Interpersonal tensions and even positive interactions such as high excitement can negatively impact an individual’s breathlessness. Nurses may make psychosocially calming suggestions to decrease stressful interactions limiting the number of visitors at any given time.

Acupuncture:

It has been found to significantly reduce both moderate and severe dyspnea for patients suffering from end stage COPD and cancer-related breathlessness.

Relaxation techniques, music therapy, therapeutic or healing touch, and guided imagery were also reported as extremely beneficial in supporting a patient with breathlessness (Ferrell & Coyle, 2010, p. 308 and Indelicato, 2006, p. 6). The complimentary therapies listed above, not only decrease breathlessness, but also act to relieve or lessen the degree of anxiety associated with a severe acute episode of breathlessness. When the experienced breathlessness is predominantly triggered or exacerbated by emotional angst, relaxation techniques, a quiet atmosphere and a calming presence may relieve dyspnea far more quickly and effectively that pharmacologic means. Studies have shown that combinations of counselling, breathing re-training, relaxation and teaching of coping and adaptive strategies provide significant improvement in dyspnea symptom management over control groups who did not receive such therapies

References:

Downing, G. M., & Wainwright, W. (2006). Medical care of the dying. (4th ed.). Victoria, BC: Victoria Hospice Society, Learning Center for Palliative Care.

Ferrel, B. R., & Coyle, N. (Eds.). (2010). Oxford textbook of palliative nursing (3rded.). New York: Oxford University Press.

Indelicato, R., A. (2006). Palliative care and the management of dyspnea: Nonpharmacologic interventions in the management of dyspnea. Advanced Practice Nursing eJournal. 6 (4) 1-7. Retrieved October 5, 2011 from http://www.medscape.com/viewarticle/551364_6.

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