Palliation of breathlessness

  • Carol L. Davis
Part of the Cancer Treatment and Research book series (CTAR, volume 100)


The semantics of breathlessness has the potential to cause confusion. The terms dyspnea (spelled dyspnoea in the United Kingdom), breathlessness, and shortness of breath are sometimes used interchangeably. I prefer to use the term breathlessness, since it is a word readily understood by patients and frequently used by them. A variety of definitions have been proffered, some physiological, others etiological or functional or in terms of quality of life. The one suggested by Guz is particularly attractive, since it highlights several important aspects including the fact that breathlessness is an occasional, normal phenomenon in healthy people:’ Breathlessness is that common feeling of an uncomfortable difficulty in breathing’ [1].


Chronic Obstructive Pulmonary Disease Palliative Care Airway Obstruction Malignant Pleural Effusion Opioid Drug 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Campbell EJM, Guz A. 1981 Breathlessness. In Hornbein TF (ed), Regulation of Breathing, unit 9, vol. 2. New York: Marcel Dekker, 1181–1192.Google Scholar
  2. 2.
    Davis CL. 1997. ABC of palliative care: breathlessness, cough and other respiratory problems. Br Med J 315:931–934.CrossRefGoogle Scholar
  3. 3.
    Saunders C. 1967. The Management of Terminal Illness. London: Edward Arnold.Google Scholar
  4. 4.
    Muers MF. 1993. Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation, Thoracic Group. Thorax 48:339–343.PubMedCrossRefGoogle Scholar
  5. 5.
    Krech RL, Davis J, Walsh TD, Curtis EB. 1992. Symptoms of lung cancer. Palliat Med 6:309–315.CrossRefGoogle Scholar
  6. 6.
    Reuben DB, Mor V. 1986. Dyspnoea in terminally ill cancer patients. Chest 89:234–236.PubMedCrossRefGoogle Scholar
  7. 7.
    Heyse-Moore LH. 1984. Dyspnoea. In Saunders C (ed), The Management of Terminal Malignant Disease. London: Edward Arnold, 113–118.Google Scholar
  8. 8.
    Hockley JM, Dunlop R, Davies RJ. 1988. Survey of distressing symptoms in dying patients and their families in hospital and the response to a symptom control team. Br Med J 296:1715–1717.CrossRefGoogle Scholar
  9. 9.
    Heyse-Moore LH, Ross V, Mullee MA. 1991 How much of a problem is dyspnoea in advanced cancer? J R Soc Med 82:264–267.Google Scholar
  10. 10.
    Heyse-Moore LH. 1989. Symptom control in palliative medicine: an update. Br J Clin Pract 43:273–276.PubMedGoogle Scholar
  11. 11.
    Bredin M, Krishnasamy M, Corner J, Plant H, Bailey C, A’Hern R. 1999. Multi-centre randomised controlled trial of intervention for breathlessness in patients with lung cancer. Br Med J. 318:901–904.CrossRefGoogle Scholar
  12. 12.
    Filshie J, Penn K, Ashley S, Davis CL. 1996. Acupuncture for the relief of cancer-related breathlessness. Palliat Med 10:145–150.PubMedCrossRefGoogle Scholar
  13. 13.
    Swinburn CR, Mould H, Stone TN, et al. 1991 Symptomatic benefit of supplemental oxygen in hypoxemic patients with chronic lung disease. Am Rev Respir Dis 143:913–915.PubMedGoogle Scholar
  14. 14.
    Davidson AC, Leach R, George RJD, Geddes DM. 1988. Supplemental oxygen and exercise ability in chronic obstructive airways disease. Thorax 43:965–971PubMedCrossRefGoogle Scholar
  15. 15.
    Woodcock AAS, Gross ER, Geddes DM. 1981 Oxygen relieves breathlessness in pink puffers. Lancet i(8226):907–909.CrossRefGoogle Scholar
  16. 16.
    Liss HP, Grant BJB. 1988. The effect of nasal flow on breathlessness in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 137:1285–1288.PubMedGoogle Scholar
  17. 17.
    Bruera E, de Stoutz N, Velasco-Leiva A, Schoeller T, Hanson J. 1993. Effects of oxygen on dyspnea in hypoxaemic terminal-cancer patients. Lancet 342:13–14.PubMedCrossRefGoogle Scholar
  18. 18.
    Booth S, Kelly MJ, Cox NP, Adams L, Guz A. 1996. Does oxygen help dyspnea in patients with cancer? Am J Respir Crit Care Med 153:1515–1518.PubMedGoogle Scholar
  19. 19.
    Bruera E, Schoeller T, MacEachern T. 1992. Symptomatic benefit of supplemental oxygen in hypoxemic patients with terminal cancer: the use of the N of 1 randomized controlled trial. J Pain Symptom Manage 7:365–368.PubMedCrossRefGoogle Scholar
  20. 20.
    Sessle BJ, Greenwood LF, Lund JP, Lucier GE. 1978. Effects of upper respiratory tract stimuli on respiration and single respiratory neurons in the adult cat. Exp Neurol 6:245–259.CrossRefGoogle Scholar
  21. 21.
    Sant’ Ambrogio G, Mathew OP, Sant’ Ambrogio FB, Fisher JT. 1985. Laryngeal cold receptors. Respir Physiol 59:35–44.CrossRefGoogle Scholar
  22. 22.
    Burgess KR, Whitelaw WA. 1984. Reducing ventilatory response to carbon dioxide by breathing cold air. Am Rev Respir Dis 129:687–690.PubMedGoogle Scholar
  23. 23.
    McBride B, Whitelaw WA. 1981 A physiological stimulus to upper airway receptors in humans. J Appl Physiol 51:1189–1197.PubMedGoogle Scholar
  24. 24.
    Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Woodrow Weiss J. Cold Facial Stimulation Reduces Breathlessness Induced in Normal Subjects, 1–4.Google Scholar
  25. 25.
    Reid RT, Rudd RM. 1993. Management of malignant pleural effusion. Thorax 48:779–780.PubMedCrossRefGoogle Scholar
  26. 26.
    Wong PS, Goldstraw P. 1991 Pleuroperitoneal shunts. Br J Hosp Med 50:16–21Google Scholar
  27. 27.
    Simonds AK, Irving JD, Clarke SW, Dick R. 1989. Use of expandable metal stents in the management of bronchial obstruction. Thorax 44:680–681PubMedCrossRefGoogle Scholar
  28. 28.
    Cooper JD, Pearson FG, Paterson CA, Todd GR, Ginsberg RJ. 1989. Use of silicone stents in the management of airway problems. Ann Thorac Surg 47:371–378.PubMedCrossRefGoogle Scholar
  29. 29.
    Congleton J, Muers M. 1995. The incidence of airflow obstruction in bronchial carchoma, its relation to breathlessness and response to bronchiodilator therapy. Respir Med 89:291–296.PubMedCrossRefGoogle Scholar
  30. 30.
    Rall TW. 1990. Drugs used in the treatment of asthma. In Goodman LS, Gillman A, Rall TW, et al. (eds), The Parmacological Basis of Therapeutics, 8th ed. New York: Pergamon Press, 618–630.Google Scholar
  31. 31.
    Rees PJ. 1991 Theophylline in the treatment of asthma. Br J Clin Pharmacol 45:9–10.Google Scholar
  32. 32.
    Van der Heijden HFM, Dekhuijzen PNR, Folgering H, van Herwaarden CLA. 1996. Topical review: pharmacotherapy of respiratory muscles in chronic obstructive pulmonary disease. Respir Med 90:513–522.PubMedCrossRefGoogle Scholar
  33. 33.
    Mikami M, Tatsumi K, Kimura H, Honda Y, Kuriyara T. 1989. Respiration effect of synthetic progestin in small doses in normal men. Chest 96:969–970.CrossRefGoogle Scholar
  34. 34.
    Stark RD, Gambles SA, Lewis JA. 1981 Methods to assess breathlessness in healthy subjects: a critical evaluation and aplication to analyse the acute effects of diazepam and promethazine on breathlessness induced by exercise or by exposure to raised levels of carbon dioxide. Clin Sci 61:429–439.PubMedGoogle Scholar
  35. 35.
    Woodcock AA, Gross ER, Geddes DM. 1981 Drug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers. Br Med J 283:343–346.CrossRefGoogle Scholar
  36. 36.
    Man GCW, Hsu K, Sproule BJ. 1986. Effect of alprazolam on exercise and dyspnea in patients with chronic obstructive pulmonary disease. Chest 90:832–836.PubMedCrossRefGoogle Scholar
  37. 37.
    Mitchell-Heggs P, Murphy K, Minty K, et al. 1980. Diazepam in the treatment of dyspnoea in the pink puffer syndrome. Q J Med 49:9–20.PubMedGoogle Scholar
  38. 38.
    Hosaka M, Hoshiyama Y. 1996. Effects of diazepam on quality of life in patients receiving home oxygen therapy: a double-blind, crossover, placebo-controlled clinical trial. J Showa Med Assoc 56:522–529.Google Scholar
  39. 39.
    Jordan C. 1982. Assessment of the effects of drugs on respiration. Br J Anaesth 54:763–782.PubMedCrossRefGoogle Scholar
  40. 40.
    O’Neill PA, Morton PB, Stark RD. 1985. Chlorpromazine — a specific effect on breathlessness? Br J Clin Pharmacol 19:793–797.CrossRefGoogle Scholar
  41. 41.
    Rice KL, Kronenberg RS, Hedemark LL, Niewoehner DE. 1987. Effects of chronic administration of codeine and promethazine on breathlessness and exercise tolerance in patients with chronic airflow obstruction. Br J Dis Chest 81:287–292.PubMedCrossRefGoogle Scholar
  42. 42.
    Ventafridda V, Spoldi E, De Conno F 1990. Control of dyspnoea in advanced cancer patients. Chest 6:1544–1545.CrossRefGoogle Scholar
  43. 43.
    Wilson RH, Hoseth W, Dempsey ME. 1954. Respiratory acidosis: effects of decreasing respiratory minute volume in patients with chronic pulmonary emphysema, with specific reference to oxygen, morphine and barbiturates. Am J Med 17:464–470.PubMedCrossRefGoogle Scholar
  44. 44.
    Walsh TD. 1984. Opiates and respiratory function in advanced cancer. Recent Results Cancer Res 89:115–117.PubMedCrossRefGoogle Scholar
  45. 45.
    Bruera E, Macmillan K, Pither J, MacDonald RN. 1990. Effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage 5:341–344.PubMedCrossRefGoogle Scholar
  46. 46.
    Cohen MH, Johnston Anderson A, Krasnow SH, Spagnolo SV, Citron ML, Payne M, Fossieck BE Jr. 1991 Continuous intravenous infusion of morphine for severe dyspnea. South Med J 84(2):229–234.PubMedCrossRefGoogle Scholar
  47. 47.
    Bruera E, MacEachern T, Ripamonti C, Hanson J. 1993. Subcutaneous morphine for the dyspnea of terminal cancer patients. Ann Intern Med 119(9):906–907.PubMedGoogle Scholar
  48. 48.
    Boyd K, Kelly M. 1997. Oral morphine for dyspnoea in cancer patients? Palliat Med 11:277–281PubMedCrossRefGoogle Scholar
  49. 49.
    Ahmedzai S, Davis C. 1997. Nebulised drugs in palliative care. Thorax 52(Suppl 2):S75–77.PubMedCrossRefGoogle Scholar
  50. 50.
    Davis C. 1996. The role of nebulized drugs in palliating respiratory symptoms of malignant disease. Eur J Palliat Care 2:12–15.Google Scholar

Copyright information

© Springer Science+Business Media New York 1999

Authors and Affiliations

  • Carol L. Davis

There are no affiliations available

Personalised recommendations