By Dr Scott Claxton
This post first appeared in Medical Forum (August 2024) and has been edited.
Key messages
- Chronic breathlessness has many causes and is very disabling
- Management is focused on improving symptoms and not cure
- Exercise and pulmonary rehabilitation programmes still offer value in even severe cases
Chronic breathlessness, or dyspnoea, significantly impacts patients with severe lung or heart disease and can also be a troublesome symptom in various cancers and other chronic conditions. Managing this symptom involves recognizing its persistent and often progressive nature, aiming to ease the discomfort and enhance quality of life rather than resolving it completely.
Key Aspects of Managing Chronic Breathlessness:
- Understanding the Symptom:
- Physiological Basis: Breathlessness arises from a complex interaction between the physiological need for ventilation (breathing) and the patient’s cortical (conscious) responses to the effort of breathing. This involves signals from the airways, respiratory muscles, lung tissue, and chemoreceptors, which are processed by the medulla (the breathing control centre) and then conveyed to the cortex, creating a conscious awareness of breathing.
- Emotional Impact: The emotional response to breathlessness varies significantly between individuals and contexts. For instance, the distress experienced by someone with severe lung disease during routine activities differs markedly from that of a healthy individual who is breathless after strenuous exercise.
- Management Strategies:
- Pharmacological Approaches:
- Low-Dose Opiates: Medications like sustained-release morphine (e.g., Kapanol 10mg) can help by reducing baseline breathlessness. Short-acting opiates may be used around activities but can cause constipation as a side effect. The recent removal of liquid morphine from the market in Australia has made this approach more challenging.
- Benzodiazepines: While they have minimal benefit and pose risks due to sedation, they may be considered for patients with significant anxiety contributing to their breathlessness.
- Non-Pharmacological Approaches:
- Exercise and Pulmonary Rehabilitation: Even with severe lung disease, tailored exercise and pulmonary rehabilitation can improve physical conditioning and aid in breathlessness management. Techniques like pursed-lipped breathing and supportive postures (e.g., tripoding) can help manage dyspnea during and after exertion.
- Oxygen Therapy: Beneficial for some patients, especially those with exertional hypoxia, though it might also provide relief simply from the sensation of airflow.
- Other Techniques: Using a handheld fan or inhaling menthol might offer temporary relief by providing a cooling sensation to the airways, reducing the unpleasant aspects of breathlessness.
Future Directions:
Research into more effective management strategies for chronic breathlessness is ongoing. There is a need to better understand the underlying mechanisms and to develop interventions that can more effectively alleviate this distressing symptom.
In summary, managing chronic breathlessness is about improving patient comfort and quality of life through a combination of pharmacological and non-pharmacological strategies, while acknowledging the complexity and persistence of the symptom.