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End of Life Online Curriculum

Overview

Assisted Suicide

 Palliative Sedation  
Communication

Opioid Conversion

Transition to Death

 
Home Hospice

Dyspnea

Bereavement

  
Prognostication

     
 

 

Dyspnea: How to Assess and Palliate Dyspnea (Air-Hunger)

  
 

Introduction & Learning Objectives
Overview

Normal Breathing
Prevalence

Patient Distress
Pathophysiology
Causes Flowchart

Assessment

Flowchart 1
Flowchart 2
Flowchart 3
Tools
Palliation

Specific Situations

Case 1: John Silver (a 67 year old man with dyspnea)

Pearls
Resources
Authors

Appendices

Assessment

The approach to evaluating dyspnea in terminally ill patients is different from other clinical settings because almost all of patients in palliative care have known incurable advanced diseases which clearly contribute to many of their symptoms including dyspnea. New or worsening dyspnea warrants looking for the causes with the aim of improving the patient's quality of life. The decision to pursue aggressive workups or interventions should carefully be weighed against the patient’s dying trajectory and the goals of care.

Evaluation of Dyspnea

Chronicity

  

Is the patient constantly breathless or is the breathlessness precipitated by certain activities?

When did the patient first notice being breathless?

Intensity

Subjective

How does the patient rate the intensity of dyspnea?

Consider using self report measures like the Visual Analog Scale or the numerical scale (Can you please rate your breathlessness on a scale of 0-10, with '0' being no breathlessness and '10' being the worst breathlessness you have ever had in your life?) (CF-10) similar to pain assessment.

Objective

Intensity of dyspnea in terminally ill patients can be assessed by bedside observation (e.g. unable to talk, or eat uninterruptedly for breath) and by caregiver reports.

The American Thoracic Society's Functional Dyspnea Scale is useful.
Two potentially useful tools in terminally ill patients may be number counting and breath holding (Wilcock 1999) (Taskar 1995).

See Assessment Tools.

Many other assessment tools have been developed, but usefulness in a terminally ill patient population is often limited.

 

2006-05-01 Update

 
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Home | Project Website | ©End of Life Curriculum Project, a joint project of the US Veterans Administration and SUMMIT, Stanford University Medical School. Funded by a grant to the Veterans Administration Nationwide Palliative Care Network by the National Library of Medicine. VJ Periyakoil, Principal Investigator.