Breathlessness (palliative care)

Chapter 9: Breathlessness 

Description:

Breathlessness is one of the most difficult and challenging of symptoms. To breathe is to be alive and it is not surprising that any threat to breathing as a result of illness evokes profound physical and emotional discomfort and distress. This chapter provides a broad overview of breathlessness in patients receiving palliative care. It draws on a variety of research studies and other literature on the subject and outlines the most appropriate management strategies in the palliative-care setting.

It is hoped that this chapter will encourage nurses and other practitioners to develop their knowledge and confidence in addressing the problem of breathlessness and that it will help them to trust in their own capacity to make a real difference for patients—even when this feels like an impossibly difficult task.

Topics:

• Introduction
• What is breathlessness?
• Prevalence of breathlessness in advanced disease
• Causes of breathlessness
• A model of breathlessness
• Assessment and measurement of breathlessness
• Management of breathlessness
  • Primary disease interventions
  • Symptomatic interventions
    • Opioids
    • Benzodiazepines and phenothiazines
    • Nebulised drugs, systemic corticosteroids, and bronchodilators
    • Oxygen therapy
• Nursing management of breathlessness
  • An integrated approach to managing breathlessness
  • Developing a therapeutic relationship
  • Cognitive strategies—understanding anxiety
  • Behavioural strategies—skills to control anxiety
    • Breathing retraining
    • Relaxation and visualization
    • Activity-pacing and goal-setting
• Summary of key points
• Conclusion

Author / Speaker:

Mary Bredin

Mary is a registered general nurse with postgraduate qualifications in complementary health studies and a background in cancer and palliative care nursing. Her specific interest in the subject of breathlessness began in 1996 when she became coordinator of a study to evaluate nursing intervention for breathlessness in patients with lung cancer at the Macmillan Practice Development Unit (MPDU) at the University of Manchester (UK). The MPDU was set up in May 1994 to provide information and to conduct research studies relevant to the needs of Macmillan Nurses. At the same time, she worked as a practitioner in a breathlessness clinic.

Mary has now left the MDPU to be with her young daughter and to train as a counsellor at Sussex University (UK). She continues to teach and write about breathlessness and is interested in incorporating psychodynamic theory into her work on this subject.

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