PHYSIOLOGY and MANAGEMENT of BREATHLESSNESS
LEAFLETS FOR PATIENTS:
www.cks.nhs.uk/palliative_cancer_care_dyspnoea/leaflets_for_patients
phyllistuckwellhospice.org/files/active/0/Managing_breathlessness.pdf
NHS Clinical Knowledge Summary on SOB in palliative care:
www.cks.nhs.uk/palliative_cancer_care_dyspnoea
Abernethy AP, McDonald CF, Frith PA (2010) Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet, 376, 9743, 784-93
www.ncbi.nlm.nih.gov/pubmed/20816546
oxygen does not relieve breathlessness
Ahmedzai SH (2004) A double blind, randomised, controlled phase II trial of Heliox28 gas mixture in lung cancer patients with dyspnoea on exertion. Br J Cancer, 90, 366-71
Heliox reduces dyspnoea on exertion and increases exercise capacity
Ambrosino N (2006) Is there any treatment other than drugs to alleviate dyspnea in COPD patients? Int J Chron Obstruct Pulmon Dis, 1, 4, 355361.
useful description of the mechanics of SOB
Ambrosini N, Scano G (2001) Measurement and treatment of dyspnoea. Respir Med, 95, 539-47
American Thoracic Society (1999) Dyspnea - mechanisms, assessment and management: a consensus statement. Am J Respir Crit Care Med,159, 321-340
Barnes D (2010) Breathlessness in advanced disease 1: definitions, epidemiology and pathophysiology. Nurs Times, 106: 43
www.allbusiness.com/medicine-health/diseases-disorders-respiratory/15250843-1.html
Barnes D (2010) Breathlessness in advanced disease 2: patient assessment and management . Nurs Times, 106, 44
www.allbusiness.com/medicine-health/diseases-disorders-blood-anemia/15266549-1.html
Bauldoff GS (2009) Music: more than just a melody. Chron Respir Dis, 6, 195-7
crd.sagepub.com/cgi/pdf_extract/6/4/195?rss=1
close association between anxiety and breathlessness, so relief of one symptom often relieves the other
music reduces anxiety during exercise in COPD patients, as well as in surgical, ICU and MI patients (so long as music suits patients preferences)
Bausewein C (2007) Measurement of breathlessness in advanced disease: a systematic review. Respir Med 101, 399-410
Bausewein C, et al (2008) Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases. Cochrane Database of Systematic Reviews; Issue 2.
Bestall JC (1996) The MRC breathlessness score as a means of stratification of COPD patients. Eur Respir J, 9(23), 383s.
rehab increases exercise tolerance and quality of life
Booth S (2004) The use of oxygen in the palliation of breathlessness. A report of the expert working group of the scientific committee of the association of palliative medicine. Resp Med, 98, 66-77
www.sciencedirect.com/science?_ob=ArticleURL&_aset=V-WA-A-W-W-MsSAYWW-UUA-U-AAWAUDDBYZ-AAAYZCYAYZ-AZCDZADEB-W-U&_rdoc=1&_fmt=summary&_udi=B6WWS-49SNBV4-1&_coverDate=01%2F31%2F2004&_cdi=7138&_orig=search&_st=13&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=6ac62da1693b520bc2d55a0954bf224e
there is little evidence for oxygen relieving SOB; a formal assessment must be made to ensure it reduces breathlessness and improves quality of life
Booth S (2006) Palliative care for intractable breathlessness in cancer. Eur J Cancer Care 15(3), 303-314
Booth S, Moosavi SH, Higginson IJ (2008) The etiology and management of intractable breathlessness in patients with advanced cancer: a systematic review of pharmacological therapy. Nat Clin Pract Oncol, 5, 2, 90-100
like pain, breathlessness has sensory (intensity) and affective (emotional) components
optimum management involves pharmacological treatment (principally opioids, occasionally oxygen and anxiolytics) and nonpharmacological interventions (including use of a fan, a tailor-made exercise program, and psychoeducational support for patient and family)
Burdon JGW (1994) Chronic lung disease and the perception of breathlessness. Eur Respir J, 7, 1342-9.
Burki NK, Lee L-Y (2010) Mechanisms of Dyspnea. Chest, 138, 5, 11961201.
www.ncbi.nlm.nih.gov/pmc/articles/PMC2972628/?tool=pmcentrez
Carrieri V, Douglas MK (1993) Desensitisation and guided mastery: treatment approaches for the management of dyspnea. Heart Lung, 22, 226-34
Christenbery TL (2005) Dyspnea self-management strategies: Use and effectiveness as reported by patients with COPD. Heart Lung, 34, 6, 406-14
the most helpful strategies were associated with movement and/or pacing
Clemens K, Klaschik E (2007) Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. J Pain Symptom Management, 33, 473-481.
Clini E, Ambrinoso N (2008) Non-pharmacological treatment and relief of symptoms in chronic obstructive pulmonary disease. Euro Respir J, 32, 218-228.
www.erj.ersjournals.com/content/32/1/218.full?sid=8e5e21f8-87fc-420d-a14b-52b47732fbd5
pulmonary rehab, oxygen, NIV, surgery, nutrition, drugs.
Collins EG et al (2001) Breathing pattern retraining and exercise in persons with COPD. AACN Clin Issues, 12, 202-9.
literature review
Cullen DL, Rodak B (2002) Clinical utility of measures of breathlessness. Respir Care, 47, 986-93
relationship between measurement and management of SOB
de Souza A (2004) Descriptors of dyspnea by patients with COPD versus congestive heart failure. Heart Lung, 33, 2, 102-110
David CL (1997) Breathlessness, cough, and other respiratory problems. BMJ, 315, 931
www.ncbi.nlm.nih.gov/pmc/articles/PMC2127624/pdf/9361545.pdf
DeVito AJ (1990) Dyspnea during hospitalization for acute phase of illness as recalled by patients with COPD. Heart Lung, 19, 186-91
eloquent testimonies from patients; essential reading for those working with breathless patients
Donesky-Cuenco D, Nguyen HQ, Paul S, Carrieri-Kohlman V (2009) Yoga therapy decreases dyspnea-related distress and improves functional performance in people with chronic obstructive pulmonary disease: a pilot study. J Altern Complement Med, 15, 3, 225-34.
www.liebertonline.com/doi/abs/10.1089/acm.2008.0389
Dorman S et al (2009) Researching breathlessness in palliative care: consensus statement of the National Cancer Research. Pall Med, 23, 213-27.
Dudgeon DJ (2001) Physiological changes and clinical correlations of dyspnea in cancer outpatients. J Pain Symptom Management, 21, 5, 376-9
www.powerbreathe.com/pdf/medical/16_DudgeonJPainSympMan01pdf.pdf
Duranti R (2006) Dyspnea: the importance of a psychological approach, Respiration, 73, 739-40
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224278&Ausgabe=232249&ArtikelNr=95909&filename=95909.pdf
importance of measuring the distress as well as the intensity of breathlessness
mechanism of breathlessness
mechanism of desensitisation to breathlessness
Farquhar M (2010) Diversity of experience and impacts of caring for a patient with breathlessness in advanced COPD. Palliat Med, 24, 2, 211
Galbraith S, Fagan P, Perkins P et al (2010) Does the use of a handheld fan improve chronic dyspnea? A randomized, controlled, crossover trial. J Pain Symptom Manage, 39, 5, 831-8.
Gardiner C (2010) The effect of the Harold Shipman murders on GP prescribing for dyspnoea for end-stage COPD. Palliat Med, 24, 2, 213
proquest.umi.com.ezproxy.brighton.ac.uk/pqdweb?index=0&did=1974326301&SrchMode=3&sid=1&Fmt=6&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1273386645&clientId=109189&aid=1
the Shipman case and associated fears of litigation are key barriers to the prescription of opiates
Garrod R, Daly C, Hoarear C (2004) The effect of pursed lip breathing on exercise capacity and breathlessness in patients with COPD. ACPRC Journal, 36, 29-36
pursed lip breathing during exercise may lower post-exercise respiratory rate
Gigliotti F (2003) Exercise training improves exertional dyspnea in patients with COPD. Chest, 123, 1794 1802
www.chestjournal.org/cgi/content/full/123/6/1794?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=123&firstpage=1794&resourcetype=HWCIT
Gustafsson PM (2001) A world galloping into breathlessness. Respiration, 68, 2-3
Gysels MH, Higginson IJ (2009) Caring for a person in advanced illness and suffering from breathlessness at home: threats and resources. Pall Supportive Care, 7, 153-62
Gysels MH, Higginson IJ (2008) Access to services for patients with chronic obstructive pulmonary disease: the invisibility of breathlessness. J Pain Symptom Manage, 36, 5, 451-60.
www.ncbi.nlm.nih.gov/pubmed/18495412
the concept that best captures the experience of breathlessness is "invisibility."
a palliative care approach is identified to reduce barriers to access.
Hirayama F (2010) Breathlessness is associated with urinary incontinence in men. BMC Pulm Med, 10, 2, doi:10.1186/1471-2466-10-2
theres a significant association between incontinence and breathlessness in middle-aged and older men
Hill K, Jenkins S, Hillman DR, Eastwood PR (2004) Dyspnoea in COPD: can inspiratory muscle training help? Austr J Physiother, 50,169-80.
gateway.ut.ovid.com.ezproxy.bton.ac.uk:2048/gw2/ovidweb.cgi
excellent explanation of the physiology of breathlessness; also evidence that specific loading of the respiratory muscles can reduce SOB
Hochstetter JK, Lewis J, Soares-Smith L (2005) An investigation into the immediate impact of breathlessness management on the breathless patient: randomised controlled trial. Physiotherapy, 91, 178-85
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7CVK-4FDMYF5-1&_user=10&_handle=V-WA-A-W-WW-MsSAYVW-UUA-U-AAVVWADUCA-AAVADEDYCA-DUWYYDBZY-WW-U&_fmt=summary&_coverDate=09%2F30%2F2005&_rdoc=8&_orig=browse&_srch=%23toc%2318081%232005%23999089996%23603496!&_cdi=18081&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=e6afca57632a84535dbf6f63cb87ca9b
Hoyal C (2002) Improving the management of breathlessness using a clinical effectiveness programme. Int J Palliative Nurs, 8, 2, 78-87
Janssens JP (2000) Management of dyspnea in severe COPD. J Pain Symp Man. 19, 378-92
oxygen is not indicated for SOB, hypoxia plays a limited part in SOB
Jantarakupt P, Porock D (2005) Dyspnea management in lung cancer: applying the evidence from COPD. Oncol Nurs Forum, 32, 785-95.
Kakizaki F (1999) Preliminary report on the effects of respiratory muscle stretch gymnastics on chest wall mobility. Respir Care, 44, 409-14
stretching exercises reduces breathlessness and increases vital capacity
Leduc D, De TA (2002) Effect of chest wall vibration on the canine diaphragm during breathing. Eur Respir J, 19, 429-33
mechanical vibration of ribcage reduces SOB, possibly by stimulating the external intercostals
Lee L, Friesen M (1998) Evaluation of dyspnea during physical and speech activities in patients with pulmonary diseases. Chest, 113, 625-32
Mahler DA, Harver A (2000) Do you speak the language of dyspnea? Chest, 117, 928-9
Mahler DA et al (2003) Evaluation of dyspnea in the elderly. Clin Geriatr Med, 19, 19-33
Mahler D, Selecky PA, Harrod CG (2010) American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease
Chest, 137, 674-691
chestjournal.chestpubs.org/content/137/3/674.abstract
breathlessness must be measured and treated
importance of a opioids
comprehensive care plan
Manning HL (1995) Pathophysiology of dyspnoea. New Eng J Med, 333, 1547-52
Manning HL (2000) Dyspnea treatment. Respir Care, 45, 1342-51
Matsumoto K (2004) Chest physiotherapy changed the ventilatory mechanics in patients with COPD. Eur Respir J, 24: Suppl. 48, 291s
www.ersnet.org/ers/lr/browse/media.aspx?id_dossier=16216&id_fiche=120417
manual stretching of the respiratory muscles can reduce hyperinflation and improve vital capacity
Meek PM et al (1999) Dyspnea: mechanisms, assessment and management. Am J Respir Crit Care Med, 159, 321-40
Meek PM, Lareau SC (2003) Are self-reports of breathing effort and breathing distress stable and valid measures among persons with asthma, persons with COPD, and healthy persons? Heart Lung, 32, 5, 335-46
Michaels C (2004) The language of breathing among individuals with COPD. Heart Lung, 33, 6, 390-400
Molen B (1995) Dyspnoea: a study of measurement instruments. J.Adv.Nurs, 22, 948-56
SOB is the most common severe symptom in the last days of life
Moody L et al (2004) A focus group for caregivers of hospice patients with severe dyspnea. Am J Hospice Pall Care, 21, 121-31.
Muers M (1993) Understanding breathlessness. Lancet, 342, 1190-1
succinct overview of mechanism of breathlessness
Navigante A et al (2006) Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnoea perception in patients with advanced cancer. J Pain Symptom Manage, 31, 38-47.
Nicholls D (2000) Breathlessness. A qualitative model of meaning. Physiother, 86, 23-7
Nicholls D (2003) The experience of chronic breathlessness. Physiother Th Pract, 19, 123-36
journalsonline.tandf.co.uk/app/home/contribution.asp?wasp=1f5f84cf5b774256bd77643d1cb985a3&referrer=parent&backto=issue,2,7;journal,7,25;linkingpublicationresults,1:103876,1
Nishimura K, Izumi T (2002) Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest, 121,143440
www.chestjournal.org/cgi/content/full/121/5/1434?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1139147998566_2104&FIRSTINDEX=0&sortspec=relevance&volume=121&firstpage=1434&resourcetype=1&journalcode=chest
O'Donnell DE, Banzett RB, Carrieri-Kohlman V et al (2007) Pathophysiology of dyspnea in chronic obstructive pulmonary disease. Proc Am Thorac Soc, 4, 2, 145-68.
pats.atsjournals.org/cgi/content/full/4/2/145
comprehensive explanation of mechanism of SOB
Parshall MB et al (2002) Psychometric characteristics of dyspnea descriptor ratings in emergency department patients with exacerbated COPD. Res Nurs Health, 25, 331-4
breathless measurement
Polkey MI (1999) Ethical and clinical issues in the use of home NIV for the palliation of breathlessness in motor neurone disease. Thorax, 54, 367-71
thorax.bmjjournals.com/cgi/content/full/54/4/367?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&author1=Polkey+&andorexactfulltext=and&searchid=1128073142735_531&stored_search=&FIRSTINDEX=0&sortspec=relevance&volume=54&firstpage=367&resourcetype=1&journalcode=thoraxjnl
identification and palliation of respiratory muscle weakness and ventilatory failure, including non-invasive ventilation
Renwick D (2001) Breathlessness and quality of life in old age. Age Ageing; 30, 110-112
ageing.oxfordjournals.org/content/30/2/110.full.pdf+html
Ripamonti C (2007) Dyspnea: pathology and assessment. J Pain Symptom Management, 13, 220-32
Simon et al (2010) Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Systematic Reviews, Issue 1
Spector N, Klein D (2001) Chronic critically ill dyspneic patients: mechanisms and clinical measurement. AACN Clin Issues, 12, 220-33
Steele B (1992) The dyspnea experience. Adv.Nurs.Sci, 15, 64-76.
Strohl K, Thomas AJ (1998) Breathlessness, anxiety and respiratory physiology. Psychosom Med, 60, 680-1
www.psychosomaticmedicine.org/cgi/reprint/60/6/680.pdf
early childhood experiences may modulate respiratory drive
Thomas M et al (2010) The impact of home-based physiotherapy interventions on breathlessness during activities of daily living in severe COPD. Physiother; 96, 2, 108-119
Tobin MJ (1990) Dyspnea: pathological basis, clinical presentation and management. Arch .Intern Med, 150, 1604-12.
Travers J, Dudgeon DJ, Amjadi K et al (2007) Mechanisms of exertional dyspnea in patients with cancer. J Appl Physiol, 104, 57-66, 200
jap.physiology.org/cgi/content/full/104/1/57?maxtoshow=&hits=10&RESULTFORMAT=&fulltext=Mechanisms+of+Exertional+Dyspnea+in+Patients+with+Cancer&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT
breathlessness in patients with cancer may be due to respiratory muscle weakness.
Uronis et al (2008) Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis Br J Cancer, 98, 294-99
Von Leupoldt (2006) Sensory and affective aspects of dyspnea contribute differentially to the borg scale's measurement of dyspnea. Respiration, 73, 762-8
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=224278&Ausgabe=232249&ArtikelNr=95910
different influence of sensory and affective aspects of dyspnoea on the Borg scale
differentiation between these aspects through the use of separate rating scales could yield more detailed information
Wilson RC (1989) A comparison of the visual analogue scale and modified Borg scale for measurement of dyspnoea during exercise. Clin Sci, 76, 277-82
Wilson RC, Jones PW (1991) Differentiation between the intensity of breathlessness and the distress it evokes in normal subjects during exercise. Clin Sci, 80, 65-70.