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Palliative cancer care - dyspnoea - Management
How should I manage dyspnoea of known cause in palliative care?

  • In all cases:
  • With the person and their carers and family, determine what management interventions are appropriate for the underlying cause of the dyspnoea and the stage of illness. These may include:
    • Treatment of reversible causes in primary care, such as asthma or chronic obstructive pulmonary disease (COPD).
    • Referral for treatment of the underlying cancer if needed (e.g. radiotherapy to a tumour, drainage of a pleural effusion).
    • Referral if the cause of dyspnoea is not directly related to the underlying cancer but is more appropriately managed in secondary care (e.g. worsening COPD).
    • Emergency treatment or admission to hospital (e.g. acute airway obstruction due to tumour or superior vena cava obstruction).
  • If in doubt as to whether treatment of the underlying illness is appropriate, seek specialist advice.
Clarification / Additional information
  • The management of malignant causes of dyspnoea (e.g. tumour) should usually involve a specialist because treatment must be tailored to the person's underlying cancer and co-existing problems and because there are a large variety of treatments available. Treatment options include radiotherapy, aspiration or pleurodesis of a pleural effusion, corticosteroids, or stent when appropriate.
  • Management of severe, acute dyspnoea should be based on the cause, or symptoms should be palliated, as appropriate.
  • For immediate emergency management [Regnard and Hockley, 2004c]:
    • Sit the person upright.
    • Ensure a flow of cool air to the face.
    • Stay with the person.
    • Check oxygen saturation if a pulse oximeter is available. Start 24% oxygen if the saturation is 90% or less.
    • If the person develops stridor due to acute airway obstruction by a malignant cause, or superior vena cava obstruction, corticosteroid use may be beneficial in this situation but initiation should ideally be discussed with a palliative care consultant.
    • However, if specialist advice is not available, when needed, CKS have reviewed the feedback from expert reviewers and palliative care literature and suggest:
      • Giving a single oral dose of dexamethasone 16 mg immediately if the person can swallow. If they are unable to take oral medication, administer the dose via the intramuscular, subcutaneous (not licensed), or intravenous (IV) route (IV administration may be more difficult in primary care and should be given as a slow injection over 2 minutes).
      • If dexamethasone is not available, giving prednisolone 60 mg orally.
      • Arranging immediate admission to hospital if appropriate. However, if hospital admission is not appropriate, discuss ongoing management with an appropriate specialist.
  • Separate CKS topics deal with the management of common non-malignant causes of dyspnoea. These can often be managed in primary care, but in some cases admission to hospital or secondary care advice may be necessary. For more information, see the CKS topics on:
Basis for recommendation

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