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Shortness of breath and cough in patients in palliative care.

AbstractBACKGROUND:
Shortness of breath and cough are common, disturbing symptoms in patients receiving palliative care. They arise in 10% to 70% of patients with advanced cancer and in 60% to nearly 100% of patients with non-malignant underlying diseases, depending on the type of disease.
METHODS:
This review is based on a selective literature search in the Medline, Embase, and PsycInfo databases and on current recommendations from Germany and other countries, as well as on the authors' personal experience.
RESULTS:
Some general measures to address these problems are reassurance, development of an emergency plan, physical activity, and relaxation exercises. Supportive non-pharmacological measures may include the use of a rollator (level of evidence [LoE] 1-), a cool draft of air as from a handheld fan (LoE 1-), physiotherapy, and respiratory therapy. There is good evidence (LoE 1+) to support the administration of opioids as the medications of choice; benzodiazepines are often used, but a meta-analysis did not reveal any statistically significant benefit (LoE 1+). Expectorants can help patients who cough with marked sputum formation. Antitussants suppress the cough reflex both peripherally and centrally (LoE 1+ to 3). Opioids, including morphine (LoE 1-) and dextromethorphan (LoE 1-), are effective antitussants with low toxicity.
CONCLUSION:
In most patients, shortness of breath and cough can be relieved by a series of therapeutic measures.
AuthorsClaudia Bausewein, Steffen T Simon
JournalDeutsches Arzteblatt international (Dtsch Arztebl Int) Vol. 110 Issue 33-34 Pg. 563-71; quiz 572 (Aug 2013) ISSN: 1866-0452 [Electronic] Germany
PMID24069091 (Publication Type: Journal Article, Meta-Analysis, Review)
Topics
  • Combined Modality Therapy
  • Comorbidity
  • Cough (epidemiology, nursing)
  • Dyspnea (epidemiology, nursing)
  • Female
  • Humans
  • Incidence
  • Male
  • Mind-Body Therapies (statistics & numerical data)
  • Palliative Care (methods, statistics & numerical data)
  • Physical Therapy Modalities (statistics & numerical data)
  • Risk Factors
  • Treatment Outcome

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