ACCP issues consensus statement on managing dyspnea in advanced heart or lung disease
MKSAP Quiz: severe head and neck pain
The American College of Chest Physicians has issued a consensus statement on the management of dyspnea in advanced heart or lung disease.
Dyspnea is a common problem in patients with advanced heart or lung disease, but its treatment is not consistent. The ACCP convened an expert panel of pulmonologists, cardiologists, nurses and palliative care specialists to summarize evidence and improve treatment. The panel looked at evidence regarding “dyspnea that persists at rest or with minimal activity and is distressful despite optimal therapy of advanced lung or heart disease.”
The panel focused on five categories: measurement of patient-reported dyspnea, oxygen therapy for relief of dyspnea, other nonpharmacologic therapies for relief of dyspnea, opioid medications for relief of dyspnea and ethical issues for relief of dyspnea at the end of life. Their recommendations included the following:
- Patients should be asked to routinely and regularly rate the intensity of their breathlessness as part of a comprehensive care plan, and such ratings should be routinely documented in the medical record to help guide care.
- Supplemental oxygen can help relieve dyspnea in patients who are hypoxemic at rest or during minimal activity.
- Pursed-lip breathing and relaxation can be effective strategies for relief of dyspnea.
- Oral and/or parenteral opioids can provide dyspnea relief.
- Concerns about contributing to addiction and/or physical dependence should not limit effective treatment or palliation of dyspnea.
The consensus statement appears in the March CHEST.