An Approach to the Breathless Patient
The practical management of chronic intractable breathlessness requires a multifaceted approach i.e. a complex intervention encompassing pro-central non-pharmacological interventions, and palliative drug therapy where necessary. Treatment of the underlying disease should always be optimised and referral to other specialists may be necessary to achieve this: palliation cannot take place without a diagnosis of the cause of breathlessness. At assessment, the patient’s goals are at the centre of the care and the action plan and broader strategy are decided with them. The needs of the patient’s carer require individual attention, again built round that person’s goals. Non-pharmacological, pro-central interventions can be usefully considered by their main mode of action i.e. whether they primarily affect breathing, thinking or functioning, accepting there is a degree of overlap. As well as symptom control for breathlessness the patient needs to be assessed comprehensively as other symptoms frequently co-exist, for example fatigue, cough and pain. The latter is particularly common in those with advanced cancer. Approaches which aim to build the patient (and carer’s) wellbeing and mental resilience are also important, as living with a chronic illness is always demanding. If you are uncertain how to help an individual with difficult symptoms and need advice or a consultation contact your local palliative care service.
KeywordsPalliative Care Chronic Illness Interstitial Lung Disease Complex Intervention Complementary Therapy
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