Breathlessness Flashcards
Why is breathlessness an important symptom to consider in palliative care?
The experience of being breathless can be frightening both for patient and family, and it can
affect individuals not only physically but also emotionally and socially.
How common is breathlessness in cancer?
50-70% of patients
What does the successful treatment of breathlessness require?
A combination of pharmacological and non-pharmacological measures
Why is it necessary to determine the cause of breathlessness?
To identify any potentially reversible causes
What can the causes of breathlessness be divided into?
- Cancer-related
- Treatment-rleated
- Other cause
What are the cancer related causes of breathlessness?
- Airway obstruction
- Pleural effusion
- Anaemia
- Ascites
What are the treatment related causes of breathlessness?
- Surgery
- Radiotherapy
- Drugs causing fluid retention
What are the other causes of breathlessness?
- Infection
- Cardiac disease
- Chronic respiratory disease
- Pulmonary disease
What might be helpful when assessing a patient with breathlessness?
The presence of a carer
Why might the presence of a carer be helpful when discussing breathlessness?
Assessment requires detailed discussion, which may be difficult for the patient
What needs to be addressed when considering ‘total breathlessness’?
The physical, psychological, social, and spiritual domains
Give 2 breathlessness measurement tools?
- MRC dyspnoea scale
- Dyspnoea-12 scale
What does the MRC dyspnoea scale measure?
Physical impact of breathlessness
What does the dyspnoea-12 scale include?
Emotional factors
What is the limitation of using breathlessness measurement tools?
They are not sufficient on their own
What should the assessment of breathlessness include?
- Holistic assessment of physical, psychological, social, and spiritual domains
- Detailed history including known disease status
- Identification of any symptoms of depression and anxiety
- Impact of breathlessness on patients lifestyle
- Patients coping strategies
- Meaning and implications of symptom on patient
What it is essential to determine when managing breathlessness?
The patients aims for treatment, and the sort of therapies and investigations they are able/prepared to undergo
Give 5 examples of potentially reversible causes of breathlessness?
- Infection
- Pleural effusion
- Arrythmias
- Anaemia
- Haert failure
What may provide long-term palliation for breathlessness?
Anti-cancer treatment, chemotherapy, or radiotherapy
What should be done if breathlessness does not have a reversible cause?
Combination of pharmacological and non-pharmacological interventions should be discussed and offered to the patient
What is the aim of palliation of breathlessness?
Change the experience and perception of breathlessness, rather than changing the underlying pathology
What pharmacological interventions may be useful in breathlessness?
- Opioids
- Anxiolytics
- Nebulised bronchodilators
- Oxygen
How do opioids help in breathlessness?
Reduce ventilatory demand
Who are opioids most beneficial to in breathlessness?
Those who are breathless at rest rather than on exertion
How can anxiolytics help in breathlessness?
Help patients better cope with breathlessness by reducing anxiety
What anxiolytics are recommended for breathlessness?
- Diazepam
- Lorazepam
When are anxiolytics recommended for breathlessness?
When anxiety is substantially aggravating the breathlessness
What bronchodilator may be helpful in breathlessness?
Salbutamol
How might salbutamol be helpful in breathlessness?
By causing bronchoconstriction
Describe the role of oxygen in the management of breathlessness
It is useful for correcting hypoxia, but breathlessness is not always related to hypoxia
Who can introduce non-pharmacological interventions in breathlessness?
- Nurses
- Doctors
- Physios
- OTs
In what setting can non-pharmacological interventions for breathlessness be introduced?
- Group sessions, involving carers
- Individual consultations
Give some non-pharmacological measures for breathlessness
- Controlled breathlessness techniques
- Energy conservation
- Relaxation techniques
- Handheld fans
What do controlled breathlessness techniques involve?
- Positioning
- Pursed lip breathing
- Breathing exercises
- Coordinated breathing training
What positions can help with breathlessness?
- Supported high side lying
- Upright sitting with arms supported on pillows
- Sitting leaning forwards with arms supported on wall or windowsill
What happens to gaseous exchange when hyperventilating?
It is reduced
What can increase gaseous exchange when hyperventilating?
Pursed lip breathing
Why does pursed lip breathing help?
Because it promotes fully exhaled breath
What breathing exercises can be helpful in breathlessness?
Diaphragmatic or deep breathing
How do breathing exercises help?
They help the lungs function optimally and promote feelings of relaxation and stress reduction
How can energy conservation be achieved to reduce breathlessness?
Through better planning of everyday activities
Give an example of how energy conservation in everyday activities can be achieved?
- Some activités can be done sitting down rather than standing, e.g. dishwashing, ironing, and gardening
- Aids can make activities easier
Why are relaxation techniques an essential component of breathlessness management?
Breathlessness and anxiety are closely linked
What can help with breathlessness exacerbated by anxiety
- CBT
- Self-hypnosis
- Progressive muscular relaxation
- Visualisation
How can a handheld fan help with breathlessness?
Studies have clearly shown that a handheld fan directed against the cheek improves the sensation of breathlessness
