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Breathlessness

First line drugs Second line drugs Specialist drugs Secondary care drugs

Notes:

  • The pathophysiology of dyspnoea is complicated, usually multi-factorial and not fully understood
  • Investigations such as chest x-rays, scans and blood gases are of limited value.
  • Dyspnoea is a common symptom that can be very frightening and patients may fear that they will suffocate (choke)
  • For non-pharmacological approaches, please refer to Palliative Care Handbook.

NB: It is difficult to predict which patients will benefit from the use of oxygen other than by therapeutic trial.  Some patients may derive considerable psychological benefit, although no change in blood gases can be detected.

Please refer to alternative sections for drug preparations and information.       

Dyspnoeas at rest:       

Opiates

  • 2.5-5mg morphine 4 hourly if opioid naïve, or increase regular opioid dose by 10-30%       

Benzodiazepines

  • 2mg–15mg diazepam daily
  • 0.5–1mg lorazepam oral for acute exacerbations       

Terminal phase:       

Diamorphine

  • 5mg-20mg over 24 hours via a syringe driver       

Midazolam

  • 10-20mg over 24 hours via a syringe driver

Return to Chapter: 16. Palliative Care Guidelines

Last updated by: on 01-12-2009 15:10