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Breathlessness

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Palliative Care in Lung Disease

Part of the book series: Respiratory Medicine ((RM))

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Abstract

Breathlessness is a common and distressing symptom in advanced lung diseases. It can continue despite optimal management of known underlying condition(s), increasing towards the end of life. It is often debilitating for patients, and frightening for them and those important to them, resulting in hospital admission. The sensation of breathlessness involves much more than the lungs: three main axes are important – lung-brain, behavioural-functional and psychosocial. Assessment and treatment are orientated to address these axes, which are best addressed in combination. In addition, people with lung disease and breathlessness often have multiple other symptoms that need treatment. Assessment of breathlessness can involve single-item numerical rating scale (NRS), such as worst breathlessness, which qualitative data suggests can detect multiple changes. This should be accompanied by more comprehensive palliative care assessments, such as with the Palliative care Outcome Scale (POS). Non-pharmacological therapies, such as breathing retraining techniques, mobility aids, muscle strengthening, hand-held fan/face cooling, pacing and self-management and education, are first-line treatments with a growing evidence base. Pharmacological treatments are more limited with the only robust evidence base existing for opioids and with data on long-term effects lacking. Future research in breathlessness in palliative care lung disease requires a multidisciplinary approach, with advances needed in phenotyping, and the evaluation of potential treatments.

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Authors and Affiliations

  1. Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK

    Irene J. Higginson, Charles C. Reilly & Matthew Maddocks

  2. Department of Physiotherapy, King’s College Hospital NHS Foundation Trust, London, UK

    Charles C. Reilly

Authors
  1. Irene J. Higginson
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  2. Charles C. Reilly
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  3. Matthew Maddocks
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Correspondence to Irene J. Higginson .

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  1. College of Nursing, Medical University of South Carolina, Charleston, SC, USA

    Kathleen O. Lindell

  2. Department of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Sonye K. Danoff

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Higginson, I.J., Reilly, C.C., Maddocks, M. (2021). Breathlessness. In: Lindell, K.O., Danoff, S.K. (eds) Palliative Care in Lung Disease. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-81788-6_6

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