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Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review

INTRODUCTION: Dyspnea is prominently observed in palliative care (PC). Dyspnea can be multifactorial, primarily caused by obstructive or restrictive lung diseases or secondarily induced by various comorbidities. Numerous interventions exist, with route of administration and efficacy requiring furthe...

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Autores principales: Senderovich, Helen, Yendamuri, Akash
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Rambam Health Care Campus 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363369/
https://www.ncbi.nlm.nih.gov/pubmed/30332384
http://dx.doi.org/10.5041/RMMJ.10357
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author Senderovich, Helen
Yendamuri, Akash
author_facet Senderovich, Helen
Yendamuri, Akash
author_sort Senderovich, Helen
collection PubMed
description INTRODUCTION: Dyspnea is prominently observed in palliative care (PC). Dyspnea can be multifactorial, primarily caused by obstructive or restrictive lung diseases or secondarily induced by various comorbidities. Numerous interventions exist, with route of administration and efficacy requiring further discussion. Despite opioids being the first line of treatment, their adverse effects lead to reluctance on the side of patients to take them, creating limitations in patient management planning. OBJECTIVES: This paper reviews and highlights the role of inhalers for dyspnea management in PC. METHODS: The CINAHL, CENTRAL, and OVID databases were searched for scholarly articles on the role of inhalers in dyspnea management from 1998 to the present. A grey literature Internet search was also performed via Google, the World Health Organization, and CareSearch. Twenty-five articles relevant to the subject at hand were located and summarized. The Cochrane Systematic Reviews of Health Promotion and Public Health Interventions Handbook was consulted for structuring. RESULT: Isolated bronchodilators can be effective in dyspnea management. However, combination with opioids leads to a 52% reduction of dyspnea, demonstrating efficacy of their combined use. There is a role for conventional inhalers not only in patients afflicted with chronic obstructive pulmonary disease, but also in those where obstruction is reversible, and in cases of dyspnea not yet diagnosed. CONCLUSION: Inhalers can be utilized as adjuvant therapy to opioids, to limit opioid use, augment responses to dyspnea, and/or minimize opioid side effects, especially in opioid-naïve patients. Correct administration can increase the efficacy of short-acting beta-agonists, long-acting beta-agonists, short- and long-acting anticholinergic agents, and inhaled corticosteroids, achieving reduction and alleviation of dyspnea.
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spelling pubmed-63633692019-02-15 Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review Senderovich, Helen Yendamuri, Akash Rambam Maimonides Med J Review Article INTRODUCTION: Dyspnea is prominently observed in palliative care (PC). Dyspnea can be multifactorial, primarily caused by obstructive or restrictive lung diseases or secondarily induced by various comorbidities. Numerous interventions exist, with route of administration and efficacy requiring further discussion. Despite opioids being the first line of treatment, their adverse effects lead to reluctance on the side of patients to take them, creating limitations in patient management planning. OBJECTIVES: This paper reviews and highlights the role of inhalers for dyspnea management in PC. METHODS: The CINAHL, CENTRAL, and OVID databases were searched for scholarly articles on the role of inhalers in dyspnea management from 1998 to the present. A grey literature Internet search was also performed via Google, the World Health Organization, and CareSearch. Twenty-five articles relevant to the subject at hand were located and summarized. The Cochrane Systematic Reviews of Health Promotion and Public Health Interventions Handbook was consulted for structuring. RESULT: Isolated bronchodilators can be effective in dyspnea management. However, combination with opioids leads to a 52% reduction of dyspnea, demonstrating efficacy of their combined use. There is a role for conventional inhalers not only in patients afflicted with chronic obstructive pulmonary disease, but also in those where obstruction is reversible, and in cases of dyspnea not yet diagnosed. CONCLUSION: Inhalers can be utilized as adjuvant therapy to opioids, to limit opioid use, augment responses to dyspnea, and/or minimize opioid side effects, especially in opioid-naïve patients. Correct administration can increase the efficacy of short-acting beta-agonists, long-acting beta-agonists, short- and long-acting anticholinergic agents, and inhaled corticosteroids, achieving reduction and alleviation of dyspnea. Rambam Health Care Campus 2019-01-28 /pmc/articles/PMC6363369/ /pubmed/30332384 http://dx.doi.org/10.5041/RMMJ.10357 Text en Copyright: © 2019 Senderovich and Yendamuri. This is an open-access article. All its content, except where otherwise noted, is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Review Article
Senderovich, Helen
Yendamuri, Akash
Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review
title Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review
title_full Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review
title_fullStr Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review
title_full_unstemmed Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review
title_short Management of Breathlessness in Palliative Care: Inhalers and Dyspnea—A Literature Review
title_sort management of breathlessness in palliative care: inhalers and dyspnea—a literature review
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6363369/
https://www.ncbi.nlm.nih.gov/pubmed/30332384
http://dx.doi.org/10.5041/RMMJ.10357
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