title: Chronic refractory dyspnoea--evidence based management.
abstract: BACKGROUND
  Chronic refractory dyspnoea is defined as breathlessness daily for 3 months at rest or on minimal exertion where contributing causes have been treated maximally. Prevalent aetiologies include chronic obstructive pulmonary disease, heart failure, advanced cancer and interstitial lung diseases.
  
  
  OBJECTIVE
  To distil from the peer reviewed literature (literature search and guidelines) evidence that can guide the safe, symptomatic management of chronic refractory dyspnoea.
  
  
  CONCLUSIONS
  Dyspnoea is mostly multifactorial. Each reversible cause should be managed (Level 4 evidence). Non-pharmacological interventions include walking aids, breathing training and, in chronic obstructive pulmonary disease, pulmonary rehabilitation (Level 1 evidence). Regular, low dose, sustained release oral morphine (Level 1 evidence) titrated to effect (with regular aperients) is effective and safe. Oxygen therapy for patients who are not hypoxaemic is no more effective than medical air. If a therapeutic trial is indicated, any symptomatic benefit is likely within the first 72 hours.
authors.affiliation: Department of Respiratory Medicine, Christchurch Hospital, New Zealand. rlwiseman@gmail.com
authors.forename: Rachel
authors.initials: R
authors.lastname: Wiseman
authors.forename: Debra
authors.initials: D
authors.lastname: Rowett
authors.forename: Peter
authors.initials: P
authors.lastname: Allcroft
authors.forename: Amy
authors.initials: A
authors.lastname: Abernethy
authors.forename: David C
authors.initials: DC
authors.lastname: Currow
mesh_terms: D001569:Benzodiazepines / Q000627:therapeutic use; D002908:Chronic Disease; D004417:Dyspnea / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy*; D006333:Heart Failure / Q000150:complications; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000150:complications; D009020:Morphine / Q000627:therapeutic use; D019636:Neurodegenerative Diseases / Q000150:complications; D010102:Oxygen Inhalation Therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D011788:Quality of Life; D016138:Walking
chemical_list: D001569:Benzodiazepines; D009020:Morphine