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Dyspnea in palliative care

Key sources
The following summarized guidelines for the evaluation and management of dyspnea in palliative care are prepared by our editorial team based on guidelines from the Global Initiative for Chronic Obstructive Lung Disease (GOLD 2023), the American Society of Clinical Oncology (ASCO 2021), the American Thoracic Society (ATS 2020), the European Respiratory Society (ERS 2017), the British Thoracic Society (BTS 2015), and the Canadian Thoracic Society (CTS 2011).
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Guidelines

1.Diagnostic investigations

Clinical assessment
Obtain a systematic assessment of dyspnea using validated patient-reported outcome measures at every inpatient and outpatient encounter in patients with advanced cancer. Use a validated observation measure in patients unable to self-report.
B
Obtain a comprehensive assessment of the severity, chronicity, potential causes, triggers, associated symptoms, and emotional and functional impact in patients with dyspnea, whenever possible.
B
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2.Respiratory support

Airflow interventions: as per GOLD 2023 guidelines, consider offering a fan blowing air onto the face to relieve dyspnea in patients with advanced COPD.
C

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  • Supplemental oxygen

  • Noninvasive ventilation

3.Medical management

General principles: refer patients with advanced cancer and dyspnea to an interprofessional palliative care team where available.
B

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  • Management of underlying conditions

  • Opioids

  • Benzodiazepines

  • Corticosteroids

  • Bronchodilators

  • Sedation

  • Therapies with no evidence for benefit

4.Nonpharmacologic interventions

Breathing techniques: as per ASCO 2021 guidelines, consider offering breathing techniques for dyspnea in patients with advanced cancer.
C

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  • Walking aids

  • Nutritional support

  • Alternative and complementary therapies

5.Therapeutic procedures

Neuromuscular electrical stimulation: as per GOLD 2023 guidelines, consider offering neuromuscular electrical stimulation in patients with advanced COPD.
C