Shortness of breath and cough in patients in palliative care

Abstract

Background: Shortness of breath and cough are common, disturbing symptoms in patients receiving palliative care. They arise in 10% to 70% of patients with advanced cancer and in 60% to nearly 100% of patients with non-malignant underlying diseases, depending on the type of disease.

Methods: This review is based on a selective literature search in the Medline, Embase, and PsycInfo databases and on current recommendations from Germany and other countries, as well as on the authors' personal experience.

Results: Some general measures to address these problems are reassurance, development of an emergency plan, physical activity, and relaxation exercises. Supportive non-pharmacological measures may include the use of a rollator (level of evidence [LoE] 1-), a cool draft of air as from a handheld fan (LoE 1-), physiotherapy, and respiratory therapy. There is good evidence (LoE 1+) to support the administration of opioids as the medications of choice; benzodiazepines are often used, but a meta-analysis did not reveal any statistically significant benefit (LoE 1+). Expectorants can help patients who cough with marked sputum formation. Antitussants suppress the cough reflex both peripherally and centrally (LoE 1+ to 3). Opioids, including morphine (LoE 1-) and dextromethorphan (LoE 1-), are effective antitussants with low toxicity.

Conclusion: In most patients, shortness of breath and cough can be relieved by a series of therapeutic measures.

Figure

Treatment algorithm for shortness of breath COPD, chronic obstructive pulmonary disease; SVCS, superior vena cava syndrome Modified from: Bausewein C, Simon St T: Management of refractory breathlessness in patients with advanced cancer. Wien Med Wochenschr 2009; 159/23–24: 591–8. Reprinted with the kind permission of Springer Verlag, Vienna