title: Breathlessness in motor neurone disease: a review of the current strategies and gaps in the evidence.
abstract: OBJECTIVE
  This review on breathlessness and motor neurone disease (MND) is important, as palliative care teams are increasingly becoming involved in the complex care of these patients at an earlier stage in their illness. Subtle cognitive and behavioural changes with MND may make management more challenging. Breathlessness is a distressing symptom, impacting on both patients and carers. Assessment and expectant management of breathlessness improves the quality of life (QoL) and may minimize hospital admission.
  
  
  RESULTS
  Low-dose opioids improve the sensation of breathlessness, with minimal side-effects. It is well established that noninvasive ventilation (NIV) improves survival in patients with MND and also improves health-related QoL of patients with minimal or no bulbar symptoms. Preparation of advance care plans is essential to the provision of care in the final stages of illness in patients with MND and NIV use.
  
  
  CONCLUSIONS
  Assessment of breathlessness and its successful management improves the QoL of patients with MND. Opioids in titrated doses may play a role in this. NIV improves survival in patients with respiratory failure with minimal or no bulbar symptoms and should be offered when appropriate. Preemptive education improves the uptake and understanding of the role of NIV.
authors.affiliation: Southern Adelaide Palliative Services, Daw Park Repatriation General Hospital, Daw Park, South Australia, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Allcroft
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D001007:Anxiety / Q000523:psychology; D017028:Caregivers / Q000523:psychology; D004417:Dyspnea / Q000523:psychology / Q000628:therapy*; D006801:Humans; D016472:Motor Neuron Disease / Q000523:psychology / Q000628:therapy*; D063087:Noninvasive Ventilation / Q000379:methods* / Q000523:psychology; D010166:Palliative Care / Q000379:methods*; D010353:Patient Education as Topic; D011788:Quality of Life
chemical_list: D000701:Analgesics, Opioid