Treatment for chronic dyspnea
The first step in treatment of dyspnea is to correct what is correctable. For example, antibiotics would be given for infection, diuretics given for fluid in the lungs from heart failure, or blood thinners for a clot in the lung. If a large collection of fluid from a tumor is present between the lung and chest wall (pleural effusion), a chest tube can be inserted to drain the fluid. Medication can be inserted through the chest tube to close off the space and prevent re accumulation of the fluid. A tumor that may be pressing on a large airway and closing off a significant part of the lung can be treated with radiation to shrink the tumor and reopen the airway.
The following medications are useful in treating dyspnea that cannot be corrected or persists despite corrective treatments.
If there is underlying lung disease, such as chronic bronchitis or emphysema, medications that relieve spasm of the small airways provide relief. Medications such as salbutamol and ipratropium bromide can be given via a puffer. They are best absorbed when administered by a nebulizer, which makes the medicine into an aerosol that is inhaled by the patient.
Opioids are some of the most useful medications for treating dyspnea. Morphine, for example, works by reducing the body's sensitivity to increased levels of carbon dioxide in the blood. By doing this, the feeling of shortness of breath is reduced. If the person is breathing rapidly, which is how the body attempts to rid itself of extra carbon dioxide, opioids will suppress the rate of breathing, making the person more comfortable. If a person has not used opioids before, they should start at a low dose, such as 2.5 to 5 mg morphine every 4 hours, then gradually increase the dose until it is effective.
If the person is already using opioids for other reasons, then the dose of the opioid should be increased by approximately 25%.
If a person experiences excessive side effects from taking opioids orally, the medication can be given by nebulizer. Morphine, or another opioid such as hydromorphone, are mixed in a saline solution, which is then made into an aerosol and inhaled by the patient. To date, research has not shown any clear advantage of this method over the oral method. However, it is more expensive and requires special equipment, so it is best used only when oral administration is not working or creating unmanageable side effects.
These are medications to relieve the anxiety associated with being short of breath. By relieving the anxiety, the respiratory system is less stressed and breathing is more comfortable. These medications also have a direct suppressing effect on the respiratory system and large doses can stop breathing. However, small doses are safe and effective. One group of medications is called benzodiazepines (e.g., lorazepam, diazepam, clonazepam) and the other group is phenothiazines (chlorpromazine, haloperidol).
No one needs to suffer with shortness of breath. Although there are many causes of dyspnea, something can always be done to lessen the suffering. If you are suffering from dyspnea and your doctor or health care team does not ask you about shortness of breath, be sure to tell them. It is also useful for the doctor to know if this shortness of breath has come on gradually or suddenly and what makes it worse. Any other symptoms that are associated with the dyspnea such as cough, mucus production or pain should also be reported.