• Keep the room cool, improve air circulation with a fan or open window, and encourage relaxation and breathing techniques.
• Provide reassurance and an explanation of dyspnoea and its underlying cause.
• Encourage exercise within the person's capabilities.

In depth

• For symptomatic treatment of dyspnoea, especially in people nearing the end of life.

In depth

• If not taking an opioid: start oral morphine 2 mg or 2.5 mg. Most people can take this dose every 4 hours and as required, although people with breathlessness may not need as frequent dosing (e.g. just as required 30 minutes before exercise for dyspnoea on exertion).
• If taking a weak opioid (e.g. codeine): only continue the weak opioid if appropriate. Start oral morphine 2.5 mg to 10 mg every 4 hours and as required (or just as required 30 minutes before exercise for dyspnoea on exertion).
• If taking regular analgesic morphine: increase regular morphine dose by around 30% every 2–3 days until symptoms controlled or adverse effects prevent further dose increases.
• Reassess every 2 days and increase the dose until dyspnoea is controlled without adverse effects and the dose is stable. If regular morphine is needed throughout the day, convert to a modified-release preparation. If only one or two doses are needed each day, continue as-required doses of standard-release morphine.
• If benefit once on a stable dose and no adverse effects, calculate the total dose given over 24 hours (new total daily dose). The new 4-hourly dose is one sixth of this.

In depth

• For dyspnoea associated with acute anxiety and benefit from simple measures has been insufficient, or the person is at the end of life.

In depth

• Use diazepam (chronic anxiety-related dyspnoea symptoms), lorazepam (acute scenario), or midazolam (for intractable breathlessness when required or by continuous subcutaneous infusion).
• Dose: consider the person's age, general condition, previous benzodiazepine use, intensity of distress, and the urgency of relief. In general, start low doses for elderly and debilitated people.

In depth

• Corticosteroids may be necessary in emergency situations involving airway obstruction (see Scenario: Known cause of dyspnoea), but otherwise should ideally be initiated only by, or on the advice of, a specialist.

In depth

• If wheeze thought to be due to partial airway obstruction from a tumour, refer for definitive treatment (e.g. radiotherapy or stenting) if appropriate to the person's stage of illness. If definitive treatment is inappropriate, or there is a delay to treatment, consider a trial of bronchodilator and assess benefit. Seek specialist advice if unsure.
• For emergency management of severe airway obstruction, see Scenario: Known cause of dyspnoea.

In depth

• Consider in people with chronic dyspnoea who need symptomatic treatment despite having tried simple measures.
• Clinically assess in primary care if possible, taking into account benefit from simple measures, degree of hypoxia, underlying cause, and risk/benefit of oxygen.
• If appropriate, a trial of short-burst oxygen therapy may be initiated in primary care following assessment. Tailor to the person's needs. Long-term oxygen therapy should be initiated by a respiratory specialist.

In depth