respiratory problems

Question 2

dyspnoea of sudden onset, several days and gradual onset possible causes and treatments in palliative care

Answer 2

Question 3

Non pharmacological treatment for dyspnoea in palliative care

Answer 3

Breathlessness is often due to advancing disease and may not be reversible. If the cause of dyspnoea cannot be reversed, or is inadequately reversed, consider the following.
Non pharmacological treatment:
Dyspnoea is frightening to the patient, family and staff.
Discussion of fears and explanation are vital.
Modification of lifestyle, breathing retraining and relaxation may be beneficial.
Oxygen may help acute dyspnoea but many patients requiring palliation for breathlessness will not benefit from oxygen therapy.
A fan directed onto the face often helps dyspnoea.

Question 4

pharmacological treatment for dyspnoea in palliative care

Answer 4

Opioids:
Oral opioids decrease respiratory effort and therefore breathlessness. Improvements are seen at doses that do not cause respiratory depression Oral morphine (e.g. oramorph 2.5mg four hourly) if opioid naïve. Gradually titrate dose upwards according to response. In patients already taking oral morphine try the usual breakthrough dose.

Benzodiazepines:
* Lorazepam (0.5mg-1mg sub-lingual) may help anxiety associated with breathlessness or give relief during panic attacks.
* Midazolam (2.5mg-5mg subcut) may benefit patients who can’t tolerate oral/sub-lingual route.

Question 5

causes of cough in palliative setting

Answer 5

Cough may be caused by excessive production of fluid in the lung (e.g. excessive mucus production by tumour, bleeding from a tumour), inhaled foreign bodies, or abnormal stimulation of the airways receptors. Treat the underlying cause if possible

Question 6

treatment of cough in palliative care

Answer 6

• If the cause cannot be reversed symptomatic treatment should be started.
• If the patient is having difficulty expectorating, a trial of saline nebulisers may be helpful.
• If the cough is dry and irritating then simple linctus may help, alternatively opioids are cough suppressants (e.g. codeine linctus, normal release oral morphine).
• Remember to prescribe laxatives with opioids.