American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease.
BACKGROUND
This consensus statement was developed based on the understanding that patients with advanced lung or heart disease are not being treated consistently and effectively for relief of dyspnea.


METHODS
A panel of experts was convened. After a literature review, the panel developed 23 statements covering five domains that were considered relevant to the topic condition. Endorsement of these statements was assessed by levels of agreement or disagreement on a five-point Likert scale using two rounds of the Delphi method.


RESULTS
The panel defined the topic condition as "dyspnea that persists at rest or with minimal activity and is distressful despite optimal therapy of advanced lung or heart disease." The five domains were: measurement of patient-reported dyspnea, oxygen therapy, other therapies, opioid medications, and ethical issues. In the second round of the Delphi method, 34 of 56 individuals (61%) responded, and agreement of at least 70% was achieved for 20 of the 23 statements.


CONCLUSIONS
For patients with advanced lung or heart disease, we suggest that: health-care professionals are ethically obligated to treat dyspnea, patients should be asked to rate the intensity of their breathlessness as part of a comprehensive care plan, opioids should be dosed and titrated for relief of dyspnea in the individual patient, both the patient and clinician should reassess whether specific treatments are serving the goal of palliating dyspnea without causing adverse effects, and it is important for clinicians to communicate about palliative and end-of-life care with their patients.
Mahler
Donald A
DA
Dartmouth-Hitchcock Medical Center, Pulmonary and Critical Care Medicine, Lebanon, NH 03756-0001, USA. Donald.A.Mahler@Hitchcock.org
Selecky
Paul A
PA
Harrod
Christopher G
CG
Benditt
Joshua O
JO
Carrieri-Kohlman
Virginia
V
Curtis
J Randall
JR
Manning
Harold L
HL
Mularski
Richard A
RA
Varkey
Basil
B
Campbell
Margaret
M
Carter
Edward R
ER
Chiong
Jun Ratunil
JR
Ely
E Wesley
EW
Hansen-Flaschen
John
J
O'Donnell
Denis E
DE
Waller
Alexander
A
D002983:Clinical Competence; D032921:Consensus; D019468:Disease Management; D004417:Dyspnea / Q000209:etiology / Q000628:therapy*; D006331:Heart Diseases / Q000150:complications*; D006801:Humans; D008171:Lung Diseases / Q000150:complications*; D017410:Practice Guidelines as Topic; D014481:United States