Dyspnea
Pharmacologic and Procedures

The approach to management of dyspnea is guided by the underlying cause of dyspnea. It is important to be educated about the disease process and the reasons why you are short of breath, both to gain some reassurance, and to help you manage this symptom.

If the cause of dyspnea is due to underlying tumor or infection, then the cause must be treated, as appropriate. If it is due to fluid build-up in the lungs or heart, then the treatment may include thoracentesis and sclerosis of the lungs or pericardiocentesis and sclerosis or surgical placement of a pericardial window to prevent further fluid buildup.

Corticosteroids such as prednisone, and bronchodilators such as albuterol and metaproterenol, may give temporary relief of dyspnea that is due to pulmonary infiltration (spread of cancer cells into the lung tissue) with cancer or due to chronic obstructive pulmonary disease.

Oxygen, delivered through a nasal cannula (tube) or mask can be helpful if you are hypoxemic. In fact, it may be the only therapy required to reduce the symptom and make you feel better. Many healthcare providers will consider trying oxygen therapy first. You should be aware, however, that there are costs associated with this therapy, as well as restricted mobility and therefore this therapy should only be used if you truly benefit from it. Some studies have shown that cool, moving air, such as an open window or fan, can have a symptomatic relief in the dyspneic patient.

Opioids (such as morphine) have shown positive effects on dyspnea in patients with chronic obstructive pulmonary disease or advanced cancer. Opioids are powerful analgesics (pain-killers) and mild sedatives with powerful effects on respiration. The mechanism by which opioids work in relieving dyspnea is not well understood. Opioids have side effects which must be monitored, including constipation, lethargy (tiredness) and nausea. Studies using nebulized opioids have not been shown to be effective and this method of delivery remains controversial.

Benzodiazepines such as diazepam are helpful when there is an anxiety component to the dyspnea. Dyspnea can lead to anxiety and anxiety can worsen dyspnea. Opioids alone may break the cycle by relieving dyspnea, therefore they are usually used before benzodiazepines as first line treatment. However, treatment of anxiety does have a role in those patients for whom anxiety is a prominent component of the distress. If dyspnea is primarily the result of anxiety, then treatment of anxiety with anxiolytics (anti-anxiety medications) may be helpful.