title: Update on combined modalities for the management of breathlessness.
abstract: OBJECTIVE
  Breathlessness is a symptom which is felt as shortness of breath or tightness in the chest. The symptom of breathlessness is essentially an awareness of difficult respiration; in other words, respiration becomes an effort. The increase due to pathological change supplements the effect of exercise. In this article, the combined modalities of palliative management of breathlessness are discussed on the basis of current literature (published and indexed in PubMed from January 2009 to week 1 in January 2012). The findings were used to derive a treatment algorithm for the management of dyspnoea.
  
  
  RESULTS
  The findings in the recently published literature with treatment recommendations for the management of breathlessness were scarce. Although there are multiple clinical trials regarding treatment of breathlessness, there is a paucity of well designed, prospective, randomized controlled trials with large enough numbers of patients suffering from breathlessness and treated with combined pharmacological and nonpharmacological methods.
  
  
  CONCLUSIONS
  As yet, there is no clinical trial that can accurately reflect the far-reaching effects of combined treatment modalities of breathlessness. Therefore, at present, we would recommend combining a treatment with opioids, anxiolytics and corticosteroids accompanied by oxygen and physiotherapeutic treatment options.
authors.affiliation: Clinic for Palliative Medicine, MediClin Robert Janker Klinik, Bonn, Germany.
authors.forename: Katri Elina
authors.initials: KE
authors.lastname: Clemens
authors.forename: Markus
authors.initials: M
authors.lastname: Faust
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D004417:Dyspnea / Q000628:therapy*; D006801:Humans; D010102:Oxygen Inhalation Therapy; D010166:Palliative Care / Q000379:methods*
chemical_list: D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid; D014151:Anti-Anxiety Agents