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Review of the evidence for the management of dyspnoea in people with chronic heart failure

Oxberry, Stephen Ga; Johnson, Miriam Jb

Current Opinion in Supportive and Palliative Care: June 2008 - Volume 2 - Issue 2 - p 84–88
doi: 10.1097/SPC.0b013e3282ff122e
Respiratory problems: Edited by David C. Currow

Purpose of review To identify current management options for dyspnoeic people with chronic heart failure.

Recent findings Optimization of chronic heart failure treatment is important for symptom control and survival. This review therefore includes recent advances in cardiac treatment as well as interventions directed solely at dyspnoea management although dyspnoea is rarely a primary endpoint in cardiac trials.

Improved understanding of pathophysiology has led to the development of novel drugs. Currently their role, be it in disease management or symptom benefit, acute decompensation or stable disease, is unclear.

Cardiac resynchronization therapy appears to be helpful for both symptom control and survival. The importance of monitoring cardiac status and fluid balance is well recognized, and may be further optimized by home telemonitoring.

For dyspnoea, nonpharmacological interventions such as exercise rehabilitation or use of a fan may be helpful. There is a small evidence base for the use of opioids, but in general, pharmacological management specifically for dyspnoea remains underresearched.

Summary Optimization of cardiac drugs and devices form the basis of symptom control. Novel drug agents for chronic heart failure may have some symptom benefit. Dyspnoea as a prime endpoint in chronic heart failure remains underresearched, but there is some evidence for nonpharmacological measures and opioid use.

aClinical Fellow in Palliative Medicine, Hull York Medical School (HYMS), UK

bSenior Lecturer in Palliative Medicine, Hull York Medical School (HYMS), Scarborough, North Yorkshire, UK

Correspondence to Dr Miriam Johnson, St Catherine's Hospice, Throxenby Lane, Scarborough, YO12 5RE North Yorkshire, UK

Tel: +44 1723 351421; fax: +44 1723 356033; e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.