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Management of acute breathlessness in the person with chronic refractory breathlessness

Donesky, DorAnne

Current Opinion in Supportive and Palliative Care: September 2015 - Volume 9 - Issue 3 - p 212–216
doi: 10.1097/SPC.0000000000000153
RESPIRATORY PROBLEMS: Edited by David C. Currow and Miriam J. Johnson

Purpose of review The purpose of this review is to synthesize the current literature on classification and management of acute breathlessness that occurs in patients who are living with chronic refractory breathlessness related to cancer, cardiopulmonary, or neuromuscular disease.

Recent findings In the context of chronic refractory breathlessness, acute breathlessness can be classified as either episodic breathlessness or breathlessness crisis. Episodic breathlessness is characterized by the severity, duration, and predictability of the symptom, and by the presence or absence of a trigger such as exertion, emotion, or an environmental factor. Breathlessness crisis is more sustained, occurs at rest, and overwhelms the patient's and caregivers’ coping abilities, similar to the nontriggered unpredictable types of episodic breathlessness. Treatment of acute breathlessness focuses on alleviating the episode as quickly as possible without escalating medical intervention that may not be consistent with the patient's treatment preferences.

Summary Attention to breathlessness in the published literature has increased exponentially in the past two decades. The challenge is now to translate the research findings into relief of symptoms, suffering, and distress in those who suffer from acute and chronic breathlessness because of chronic illness.

University of California, San Francisco, California

Correspondence to DorAnne Donesky, PhD, ANP-BC, University of California, San Francisco, 2 Koret Way, N631, Box 0610, San Francisco, CA 94143-0610. Tel: +1 415 476 0984; fax: +1 415 476 8899; e-mail:

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