Dyspnea and Cough (including end-of-life)

Question 1

What is dyspnea?

Answer 1

Uncomfortable feeling of being unable to breathe appropriately, shortness of breath.

Question 2

Describe the mMRC grading system for dyspnea (0-4)

Answer 2

0: Dyspnea with strenuous exercise
1: When hurrying or walking up a slight hill
2: Patient walks slower or stops more frequently than contemporaries on flat ground due to breathlessness
3: Stops for breath after walking 100m or a few minutes on level ground
4: Too breathless to leave the house, or when dressing/undressing

Question 3

Describe the NYHA classification for heart failure (I-IV)

Answer 3

I: No limitation of ordinary physical activity
II: Slight limitation of physical activity
III: Marked limitation of physical activity (less than normal activity causes dyspnea and fatigue)
IV: Undertakes any physical activity with discomfort (symptoms of at rest)

Question 4

Name 6 mechanisms of SOB

Answer 4

Muscle weakness
Anxiety
Stiff chest wall
Obstruction to flow
Stimulation of chemoreceptors
Stimulation of pulmonary receptors

Question 5

What are common causes of dyspnea at the end of life? (4)

Answer 5

Heart failure
COPD
Cancer
Scarring

Question 6

What is chronic cough?

Answer 6

Cough lasting more than 8 weeks

Question 7

What is refractory chronic cough?

Answer 7

Persistent cough in spite of an adequate investigation and treatment of potential causes

Question 8

What are some common drugs for treatment of refractory chronic cough? (5)

Answer 8

amitriptyline
gabapentin
pregabalin
morphine
tramadol

Question 9

What is thoracocentesis?

Answer 9

Needle insertion to drain fluid from pleural cavity (e.g. in the case of a pleural effusion)

Question 10

What type of medication makes up the cornerstone of pharmacotherapy for severe dyspnea and is potent for suppressing cough and pain?

Answer 10

Opiates: morphine, codeine, fentanyl, oxycodone