gms | German Medical Science

Dyspnoea is an uncomfortable awareness of breathing that is a frequent problematic symptom in patients with advanced cancer. A subjective sensation influenced by the patient’s response to the perception of breathlessness, dyspnoea may be experienced by the patient as a mild shortness of breath or a distressing sensation of suffocation. It occurs in 30 – 75% of patients with advanced cancer and is not confined to patients with lung cancer or underlying pulmonary disease. Because dyspnoea is subjective, patients may feel short of breath without showing signs of respiratory distress, or they may overtly appear to be in distress without the sensation of breathlessness. Thus, it is imperative to ask the patient specifically about his or her perception of the symptom. The complex pathophysiology of dyspnoea is multifactorial, involving cerebrocortical centres that accept input from pulmonary receptors that respond to chemical and mechanical stimulation. The multiple underlying reasons for dyspnoea may occur individually or as concurrent problems. Generalized muscle weakness due to severe cachexia, anorexia, or asthenia may exacerbate breathlessness. Anxiety may be a provocative or aggravating factor. The primary palliative goal in managing dyspnoea is rapid subjective improvement and not abatement of physical signs of respiratory distress. Of all the centrally acting drugs, opioids have received most attention and are most widely used in the control of dyspnoea. Oxygen therapy is a rather poorly understood and often misused treatment in the palliation of breathlessness. It is sometimes seen by patients and professional staff as being less invasive than drug treatment because it does not involve the taking of medicines. However, it may be unhelpful, irrelevant, or even harmful in the same way that pharmacological interventions can be. The oxygen therapy is only indicated when a patient is hypoxaemic.