Abstract
There are many similarities in the central neurophysiology of pain and breathlessness but the treatment strategies are different. The pharmacological treatment of breathlessness lags behind that of pain in both the number of drugs available and the effectiveness of current drug regimens. There is reason for hope as increasing research is being carried out in this area. In general drug treatment is most effective in those with the most severe breathlessness or at the end of life. Oral morphine is the drug with the greatest evidence base and is most widely used. Second line treatment is open to question as there is no high quality evidence currently to support the use of benzodiazepines which are certainly useful at the end of life when sedation is needed but can promote hazardous dependency in those with months or years to live. Mirtazapine may have a more substantial rationale for its use although it has not been researched rigorously yet. In mobile patients with a lengthy prognosis non-pharmacological, procentral approaches are likely to be best approach.
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Further Reading
Booth S, Bausewein C, Higginson I, Moosavi SH. Pharmacological treatment of refractory breathlessness. Expert Rev Respir Med. 2009;3(1):21–36.
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Booth, S., Burkin, J., Moffat, C., Spathis, A. (2014). Pharmacological Management of Breathlessness. In: Managing Breathlessness in Clinical Practice. Springer, London. https://doi.org/10.1007/978-1-4471-4754-1_10
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DOI: https://doi.org/10.1007/978-1-4471-4754-1_10
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