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Dyspnoea and other respiratory symptoms in palliative care 

Dyspnoea and other respiratory symptoms in palliative care
Chapter:
Dyspnoea and other respiratory symptoms in palliative care
Author(s):

Kin-Sang Chan

, Doris M.W. Tse

, and Michael M.K. Sham

DOI:
10.1093/med/9780199656097.003.0082
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date: 07 May 2021

Dyspnoea is prevalent among palliative care patients with increased severity over time. There are two patterns of dyspnoea-breakthrough dyspnoea and constant dyspnoea-and three separate qualities of dyspnoea-air hunger, work or effort, and tightness. The measurement of dyspnoea includes three domains: sensory-perceptual experience, affective distress, and symptom impact. The management of dyspnoea includes specific disease management, non-pharmacological intervention, pharmacological treatment, and palliative non-invasive ventilation. Cough is prevalent and disturbing in patients with cancer and chronic lung diseases, and is often associated with airway hypersecretion and impaired mucociliary clearance. Management includes specific treatments for underlying non-cancer and cancer-related causes, symptomatic treatment by antitussives, mucoactive agents, and airway clearance techniques for expectoration and reduction in mucus production. Anticholinergics may be indicated for death rattles to facilitate a peaceful death. Haemoptysis occurs in 30-60% of lung cancer patients and initial management of haemoptysis includes airway protection and volume resuscitation. Localization of the site and source of bleeding may determine the choice of treatment. If a life-threatening haemoptysis occurs, sedation should be given as soon as possible. Support should be given to the family, and debriefing provided to team members.

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