Palliative management of refractory dyspnea in COPD

Hope E Uronis, David C Currow, Amy P Abernethy, Hope E Uronis, David C Currow, Amy P Abernethy

Abstract

COPD is a progressive illness with worldwide impact. Patients invariably reach a point at which they require palliative interventions. Dyspnea is the most distressing symptom experienced by these patients; when not relieved by traditional COPD management strategies it is termed "refractory dyspnea" and palliative approaches are required. The focus of care shifts from prolonging survival to reducing symptoms, increasing function, and improving quality of life. Numerous pharmacological and non-pharmacological interventions can achieve these goals, though evidence supporting their use is variable. This review provides a summary of the options for the management of refractory dyspnea in COPD, outlining currently available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled furosemide, Heliox, rehabilitation, nutrition, psychosocial support, breathing techniques, and breathlessness clinics.

Figures

Figure 1
Figure 1
The trajectory of illness of COPD follows a progressive course with declines in function alternating with periods of improvement. As the disease progresses, the focus of care shifts from life-prolonging therapies to palliative interventions aimed at reducing symptoms, improving function, and improving quality of life. Reprinted from Lunney JR, Lynn J, Hogan C. 2002. Profiles of older medicare decedents. J Am Geriatr Soc, 50:1108–12. Copyright © 2002 with permission from Blackwell Publishing Ltd.
Figure 2
Figure 2
Palliative interventions for refractory dyspnea.

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