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Campbell ML, Donesky D, Sarkozy A, et al. Treatment of Dyspnea in Advanced Disease and at the End of Life. J Hosp Palliat Nurs. 2021;23(5):406-420doi: 10.1097/NJH.0000000000000766.
Campbell, M. L., Donesky, D., Sarkozy, A., & Reinke, L. F. (2021). Treatment of Dyspnea in Advanced Disease and at the End of Life. Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association, 23(5), 406-420. https://doi.org/10.1097/NJH.0000000000000766
Campbell, Margaret L, et al. "Treatment of Dyspnea in Advanced Disease and at the End of Life." Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association vol. 23,5 (2021): 406-420. doi: https://doi.org/10.1097/NJH.0000000000000766
Campbell ML, Donesky D, Sarkozy A, Reinke LF. Treatment of Dyspnea in Advanced Disease and at the End of Life. J Hosp Palliat Nurs. 2021 Oct 01;23(5):406-420. doi: 10.1097/NJH.0000000000000766. PMID: 33883525.
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J Hosp Palliat Nurs. 2021 Oct 01;23(5):406-420. doi: 10.1097/NJH.0000000000000766.

Treatment of Dyspnea in Advanced Disease and at the End of Life.

Journal of hospice and palliative nursing : JHPN : the official journal of the Hospice and Palliative Nurses Association

Margaret L Campbell, DorAnne Donesky, Alexandra Sarkozy, Lynn F Reinke

PMID: 33883525 DOI: 10.1097/NJH.0000000000000766

Abstract

Dyspnea is a subjective experience of breathing discomfort that consists of qualitatively distinct sensations, varies in intensity, and can only be known through the patient's report. Dyspnea is akin to suffocation and is one of the most distressing symptoms experienced by patients with advanced illness and at the end of life. Common approaches to dyspnea management, such as pulmonary rehabilitation, breathing strategies, or supplemental oxygen, have become accepted through pragmatic use or because studies do not include dyspnea as a measured outcome. Patients and clinicians urgently need evidence-based treatments to alleviate this frightening symptom. To fill this gap, a group of dyspnea researchers with expertise to conduct a literature review of evidence-based interventions for dyspnea in patients with serious illness produced these guidelines. We present the evidence from the strongest recommendations for practice to the weakest recommendations and include practical considerations for clinical nurses.

Copyright © 2021 by The Hospice and Palliative Nurses Association. All rights reserved.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

References

  1. Parshall MB, Schwartzstein RM, Adams L, et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med. 2012;185(4):435–452. - PubMed
  2. Solano JP, Gomes B, Higginson IJ. A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage. 2006;31(1):58–69. - PubMed
  3. Currow DC, Smith J, Davidson PM, Newton PJ, Agar MR, Abernethy AP. Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study. J Pain Symptom Manage. 2010;39(4):680–690. - PubMed
  4. Campbell ML, Kiernan JM, Strandmark J, Yarandi HN. Trajectory of dyspnea and respiratory distress among patients in the last month of life. J Palliat Med. 2018;21(2):194–199. - PubMed
  5. Hui D, Bohlke K, Bao T, et al. Management of dyspnea in advanced cancer [epub ahead of print]. J Clin Oncol. - PubMed
  6. Mahler DA, Selecky PA, Harrod CG, et al. American College of Chest Physicians consensus statement on the management of dyspnea in patients with advanced lung or heart disease. Chest. 2010;137(3):674–691. - PubMed
  7. Marciniuk DD, Goodridge D, Hernandez P, et al. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian thoracic society clinical practice guideline. Can Respir J. 2011;18(2):69–78. - PubMed
  8. Mirza RD, Punja S, Vohra S, Guyatt G. The history and development of N-of-1 trials. J R Soc Med. 2017;110(8):330–340. - PubMed
  9. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol. 2009;62(10):1006–1012. - PubMed
  10. Oncology Nursing Society. Decision rules for summative evaluation of a body of evidence. 2019; www.ons.org/explore-resources/pep/decision-rules-summative-evaluation-body-evidence. Accessed January 14, 2019. - PubMed
  11. Jennings AL, Davies AN, Higgins JP, Gibbs JS, Broadley KE. A systematic review of the use of opioids in the management of dyspnoea. Thorax. 2002;57(11):939–944. - PubMed
  12. Ben-Aharon I, Gafter-Gvili A, Leibovici L, Stemmer SM. Interventions for alleviating cancer-related dyspnea: a systematic review and meta-analysis. Acta Oncol. 2012;51(8):996–1008. - PubMed
  13. Allard P, Lamontagne C, Bernard P, Tremblay C. How effective are supplementary doses of opioids for dyspnea in terminally ill cancer patients? A randomized continuous sequential clinical trial. J Pain Symptom Manage. 1999;17(4):256–265. - PubMed
  14. Oxberry SG, Torgerson DJ, Bland JM, Clark AL, Cleland JG, Johnson MJ. Short-term opioids for breathlessness in stable chronic heart failure: a randomized controlled trial. Eur J Heart Fail. 2011;13(9):1006–1012. - PubMed
  15. American Thoracic Society. Dyspnea. Mechanisms, assessment, and management: a consensus statement. American Thoracic Society. Am J Respir Crit Care Med. 1999;159(1):321–340. - PubMed
  16. Banzett RB, Adams L, O'Donnell CR, Gilman SA, Lansing RW, Schwartzstein RM. Using laboratory models to test treatment: morphine reduces dyspnea and hypercapnic ventilatory response. Am J Respir Crit Care Med. 2011;184(8):920–927. - PubMed
  17. Pattinson KTS, Governo RJ, MacIntosh BJ, et al. Opioids depress cortical centers responsible for the volitional control of respiration. 2009;29:8177–8186. - PubMed
  18. Barnes H, McDonald J, Smallwood N, Manser R. Opioids for the palliation of refractory breathlessness in adults with advanced disease and terminal illness. Cochrane Database Syst Rev. 2016;3:CD011008. - PubMed
  19. Thomas JR, von Gunten CF. Clinical management of dyspnoea. Lancet Oncol. 2002;3(4):223–228. - PubMed
  20. West JB. Respiratory Physiology: The Essentials. Philadelphia, PA: Lippincott, Williams and Wilkins; 1999. - PubMed
  21. Uronis H, McCrory DC, Samsa G, Currow D, Abernethy A. Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2011;6:CD006429. - PubMed
  22. Jacobs SS, Krishnan JA, Lederer DJ, et al; American Thoracic Society. Home oxygen therapy for adults with COPD and ILD: new ATS clinical practice guideline. Am J Respir Crit Care Med. 2020;202. https://doi.org/10.1164/rccm.202009-3608ST. - PubMed
  23. Swan F, Booth S. The role of airflow for the relief of chronic refractory breathlessness. Curr Opin Support Palliat Care. 2015;9(3):206–211. - PubMed
  24. Schwartzstein RM, Lahive K, Pope A, Weinberger SE, Weiss JW. Cold facial stimulation reduces breathlessness induced in normal subjects. Am Rev Respir Dis. 1987;136:58–61. - PubMed
  25. Bausewein C, Booth S, Gysels M, Kuhnbach R, Higginson IJ. Effectiveness of a hand-held fan for breathlessness: a randomised phase II trial. BMC Palliat Care. 2010;9:22. - PubMed
  26. Galbraith S, Fagan P, Perkins P, Lynch A, Booth S. Does the use of a hand-held fan improve chronic dyspnea: a randomized, controlled, crossover trial. J Pain Symptom Manage. 2010;39(5):831–838. - PubMed
  27. Luckett T, Phillips J, Johnson MJ, et al. Contributions of a hand-held fan to self-management of chronic breathlessness. Eur Respir J. 2017;50(2). - PubMed
  28. Kako J, Morita T, Yamaguchi T, et al. Fan therapy is effective in relieving dyspnea in patients with terminally ill cancer: a parallel-arm, randomized controlled Trial. J Pain Symptom Manage. 2018;56(4):493–500. - PubMed
  29. Yu S, Sun K, Xing X, et al. Fan therapy for the relief of dyspnea in adults with advanced disease and terminal illness: a meta-analysis of randomized controlled trials. J Palliat Med. 2019;22(12):1603–1609. - PubMed
  30. Nici L, Mammen MJ, Charbek E, et al; American Thoracic Society. Pharmacologic management of chronic obstructive pulmonary disease: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2020;201:e-56–69. - PubMed
  31. Gotfried MH, Kerwin EM, Lawrence D, Lassen C, Kramer B. Efficacy of indacaterol 75 mug once-daily on dyspnea and health status: results of two double-blind, placebo-controlled 12-week studies. COPD. 2012;9(6):629–636. - PubMed
  32. Mahler DA, Decramer M, D'Urzo A, et al. Dual bronchodilation with QVA149 reduces patient-reported dyspnoea in COPD: the BLAZE study. Eur Respir J. 2014;43(6):1599–1609. - PubMed
  33. Mahler DA, D'Urzo A, Bateman ED, et al. Concurrent use of indacaterol plus tiotropium in patients with COPD provides superior bronchodilation compared with tiotropium alone: a randomised, double-blind comparison. Thorax. 2012;67(9):781–788. - PubMed
  34. Sansores R, Ramirez-Vanegas A, Reddy C, Mejia-Alfaro R. Effect of the combination of two bronchodilators on breathlessness in patients with chronic obstructive pulmonary disease. A crossover clinical trial. Arch Med Res. 2003;34(4):292–297. - PubMed
  35. Tashkin DP, Donohue JF, Mahler DA, et al. Effects of arformoterol twice daily, tiotropium once daily, and their combination in patients with COPD. Respir Med. 2009;103(4):516–524. - PubMed
  36. Dowman L, Hill CJ, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2014;(10):Cd006322. - PubMed
  37. Wadell K, Webb KA, Preston ME, et al. Impact of pulmonary rehabilitation on the major dimensions of dyspnea in COPD. COPD. 2013;10(4):425–435. - PubMed
  38. Chen YJ, Li XX, Ma HK, et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. J Pain Symptom Manage. 2019. - PubMed
  39. Abernethy AP, Currow DC, Frith P, Fazekas BS, McHugh A, Bui C. Randomised, double blind, placebo controlled crossover trial of sustained release morphine for the management of refractory dyspnoea. BMJ. 2003;327(7414):523–528. - PubMed
  40. Johnson MJ, Sbizzera I, Fairhurst C, et al. No excess harms from sustained-release morphine: a randomised placebo-controlled trial in chronic breathlessness. BMJ Support Palliat Care. 2019. - PubMed
  41. Currow DC, Quinn S, Greene A, Bull J, Johnson MJ, Abernethy AP. The longitudinal pattern of response when morphine is used to treat chronic refractory dyspnea. J Palliat Med. 2013;16(8):881–886. - PubMed
  42. Mazzocato C, Buclin T, Rapin CH. The effects of morphine on dyspnea and ventilatory function in elderly patients with advanced cancer: a randomized double-blind controlled trial. Ann Oncol. 1999;10(12):1511–1514. - PubMed
  43. Ben-Aharon I, Gafter-Gvili A, Paul M, Leibovici L, Stemmer SM. Interventions for alleviating cancer-related dyspnea: a systematic review. J Clin Oncol. 2008;26(14):2396–2404. - PubMed
  44. Verberkt CA, van den Beuken-van Everdingen MHJ, Schols J, et al. Respiratory adverse effects of opioids for breathlessness: a systematic review and meta-analysis. Eur Respir J. 2017;50(5):1701153. - PubMed
  45. Global Initiative for Chronic Obstructive Lung Disease. Global Initiative for Chronic Obstructive Lung Disease global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. 2018. www.goldcopd.org. Accessed May 31, 2018. - PubMed
  46. Vitacca M, Scalvini S, Volterrani M, Paneroni M, Giordano A, Ambrosino N. Physiological and symptom effects of changing posture from sitting to supine, and vice versa, in stable chronic heart failure. Acta Cardiol. 2016;71(5):543–548. - PubMed
  47. Johnson MJ, Kanaan M, Richardson G, et al. A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease. BMC Med. 2015;13:213. - PubMed
  48. Hoffman M, Augusto VM, Eduardo DS, Silveira BMF, Lemos MD, Parreira VF. Inspiratory muscle training reduces dyspnea during activities of daily living and improves inspiratory muscle function and quality of life in patients with advanced lung disease. Physiother Theory Pract. 2019;1–11. - PubMed
  49. Carrieri-Kohlman V, Nguyen HQ, Donesky-Cuenco D, Demir-Deviren S, Neuhaus J, Stulbarg MS. Impact of brief or extended exercise training on the benefit of a dyspnea self-management program in COPD. J Cardiopulm Rehabil. 2005;25(5):275–284. - PubMed
  50. Nguyen HQ, Donesky D, Reinke LF, et al. Internet-based dyspnea self-management support for patients with chronic obstructive pulmonary disease. J Pain Symptom Manage. 2013;46(1):43–55. - PubMed
  51. Nguyen HQ, Donesky-Cuenco D, Wolpin S, et al. Randomized controlled trial of an internet-based versus face-to-face dyspnea self-management program for patients with chronic obstructive pulmonary disease: pilot study. J Med Internet Res. 2008;10(2):e9. - PubMed
  52. Wakabayashi R, Kusunoki Y, Hattori K, et al. Effectiveness of home-based exercise in older patients with advanced chronic obstructive pulmonary disease: a 3-year cohort study. Geriatr Gerontol Int. 2018;18(1):42–49. - PubMed
  53. Corner J, Plant H, A'Hern R, Bailey C. Non-pharmacological intervention for breathlessness in lung cancer. Palliat Med. 1996;10(4):299–305. - PubMed
  54. Farquhar MC, Prevost AT, McCrone P, et al. Is a specialist breathlessness service more effective and cost-effective for patients with advanced cancer and their carers than standard care? Findings of a mixed-method randomised controlled trial. BMC Med. 2014;12:194. - PubMed
  55. Higginson IJ, Bausewein C, Reilly CC, et al. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med. 2014;2(12):979–987. - PubMed
  56. Qian MYY, Politis J, Thompson M, et al. Individualized breathlessness interventions may improve outcomes in patients with advanced COPD. Respirology (Carlton, Vic). 2018;23(12):1146–1151. - PubMed
  57. Elbehairy AF, McIsaac H, Hill E, et al. Impact of a specialized ambulatory clinic on refractory breathlessness in subjects with advanced COPD: a retrospective analysis. Respir Care. 2019. - PubMed
  58. Brighton LJ, Miller S, Farquhar M, et al. Holistic services for people with advanced disease and chronic breathlessness: a systematic review and meta-analysis. Thorax. 2019;74(3):270–281. - PubMed
  59. Lau KS, Jones AY. A single session of Acu-TENS increases FEV1 and reduces dyspnoea in patients with chronic obstructive pulmonary disease: a randomised, placebo-controlled trial. Aust J Physiother. 2008;54(3):179–184. - PubMed
  60. Wu HS, Wu SC, Lin JG, Lin LC. Effectiveness of acupressure in improving dyspnoea in chronic obstructive pulmonary disease. J Adv Nurs. 2004;45(3):252–259. - PubMed
  61. Nava S, Ferrer M, Esquinas A, et al. Palliative use of non-invasive ventilation in end-of-life patients with solid tumours: a randomised feasibility trial. Lancet Oncol. 2013;14(3):219–227. - PubMed
  62. Curtis JR, Cook DJ, Sinuff T, et al. Noninvasive positive pressure ventilation in critical and palliative care settings: understanding the goals of therapy. Crit Care Med. 2007;35:932–939. - PubMed
  63. Hui D, Morgado M, Chisholm G, et al. High-flow oxygen and bilevel positive airway pressure for persistent dyspnea in patients with advanced cancer: a phase II randomized Trial. J Pain Symptom Manage. 2013;46(4):463–473. - PubMed
  64. Ruangsomboon O, Dorongthom T, Chakorn T, et al. High-flow nasal cannula versus conventional oxygen therapy in relieving dyspnea in emergency palliative patients with do-not-intubate status: a randomized crossover study. Ann Emerg Med. 2020;75(5):615–626. - PubMed
  65. Zemach S, Helviz Y, Shitrit M, Friedman R, Levin PD. The use of high-flow nasal cannula oxygen outside the ICU. Respir Care. 2019;64(11):1333–1342. - PubMed
  66. Marinari S, Manigrasso MR, De Benedetto F. Effects of nutraceutical diet integration, with coenzyme Q10 (Q-Ter multicomposite) and creatine, on dyspnea, exercise tolerance, and quality of life in COPD patients with chronic respiratory failure. Multidiscip Respir Med. 2013;8(1):40. - PubMed
  67. Vickers AJ, Feinstein MB, Deng GE, Cassileth BR. Acupuncture for dyspnea in advanced cancer: a randomized, placebo-controlled pilot trial [ISRCTN89462491]. BMC Palliat Care. 2005;4:5. - PubMed
  68. Miller KR, Patel JN, Symanowski JT, Edelen CA, Walsh D. Acupuncture for cancer pain and symptom management in a palliative medicine clinic. Am J Hosp Palliat Care. 2019;36(4):326–332. - PubMed
  69. Romeo MJ, Parton B, Russo RA, Hays LS, Conboy L. Acupuncture to treat the symptoms of patients in a palliative care setting. Explore (NY). 2015;11(5):357–362. - PubMed
  70. Pandit A, Gupta N, Kumar V, et al. Effect of palliative bronchoscopic interventions on symptom burden in patients with central airway narrowing: a retrospective review. Indian J Palliat Care. 2019;25(2):250–253. - PubMed
  71. Dransfield MT, Garner JL, Bhatt SP, et al. Effect of Zephyr endobronchial valves on dyspnea, activity levels, and quality of life at one year. Results from a randomized clinical Trial. Ann Am Thorac Soc. 2020;17(7):829–838. - PubMed
  72. Ryerson CJ, Donesky D, Pantilat SZ, Collard HR. Dyspnea in idiopathic pulmonary fibrosis: a systematic review. J Pain Symptom Manage. 2012;43(4):771–782. - PubMed
  73. Eiser N, Denman WT, West C, Luce P. Oral diamorphine: lack of effect on dyspnoea and exercise tolerance in the “pink puffer” syndrome. Eur Respir J. 1991;4(8):926–931. - PubMed
  74. Coyne PJ, Viswanathan R, Smith TJ. Nebulized fentanyl citrate improves patients' perception of breathing, respiratory rate, and oxygen saturation in dyspnea. J Pain Symptom Manage. 2002;23(2):157–160. - PubMed
  75. Pinna MA, Bruera E, Moralo MJ, Correas MA, Vargas RM. A randomized crossover clinical trial to evaluate the efficacy of oral transmucosal fentanyl citrate in the treatment of dyspnea on exertion in patients with advanced cancer. Am J Hosp Palliat Care. 2015;32(3):298–304. - PubMed
  76. Jansen K, Haugen DF, Pont L, Ruths S. Safety and effectiveness of palliative drug treatment in the last days of life—a systematic literature review. J Pain Symptom Manage. 2018;55(2):508–521.e3. - PubMed
  77. Benitez-Rosario MA, Rosa-Gonzalez I, Gonzalez-Davila E, Sanz E. Fentanyl treatment for end-of-life dyspnoea relief in advanced cancer patients. Support Care Cancer. 2019;27(1):157–164. - PubMed
  78. Currow D, Louw S, McCloud P, et al. Regular, sustained-release morphine for chronic breathlessness: a multicentre, double-blind, randomised, placebo-controlled trial. Thorax. 2019;75(1):50–56. - PubMed
  79. Aabom B, Laier G, Christensen PL, Karlsson T, Jensen MB, Hedal B. Oral morphine drops for prompt relief of breathlessness in patients with advanced cancer-a randomized, double blinded, crossover trial of morphine sulfate oral drops vs. morphine hydrochloride drops with ethanol (red morphine drops). Support Care Cancer. 2019;28(7):3421–3428. - PubMed
  80. Kamell A, Smith LK. Attitudes toward use of benzodiazepines among U.S. hospice clinicians: survey and review of the literature. J Palliat Med. 2016;19(5):516–522. - PubMed
  81. Allcroft P, Margitanovic V, Greene A, et al. The role of benzodiazepines in breathlessness: a single site, open label pilot of sustained release morphine together with clonazepam. J Palliat Med. 2013;16(7):741–744. - PubMed
  82. Peoples AR, Bushunow PW, Garland SN, et al. Buspirone for management of dyspnea in cancer patients receiving chemotherapy: a randomized placebo-controlled URCC CCOP study. Support Care Cancer. 2016;24(3):1339–1347. - PubMed
  83. Simon ST, Higginson IJ, Booth S, Harding R, Weingartner V, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2016;10:CD007354. - PubMed
  84. Navigante AH, Cerchietti LC, Castro MA, Lutteral MA, Cabalar ME. Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with advanced cancer. J Pain Symptom Manage. 2006;31(1):38–47. - PubMed
  85. Booth S, Kelly MJ, Cox NP, Adams L, Guz A. Does oxygen help dyspnea in patients with cancer?Am J Respir Crit Care Med. 1996;153(5):1515–1518. - PubMed
  86. Bruera E, de Stoutz N, Velasco-Leiva A, Schoeller T, Hanson J. Effects of oxygen on dyspnoea in hypoxaemic terminal-cancer patients. Lancet. 1993;342:13–14. - PubMed
  87. Philip J, Gold M, Milner A, Di Iulio J, Miller B, Spruyt O. A randomized, double-blind, crossover trial of the effect of oxygen on dyspnea in patients with advanced cancer. J Pain Symptom Manage. 2006;32(6):541–550. - PubMed
  88. Sepehrvand N, Alemayehu W, Rowe BH, et al. High vs. low oxygen therapy in patients with acute heart failure: HiLo-HF pilot trial. ESC Heart Fail. 2019;6(4):667–677. - PubMed
  89. Albert RK, Au DH, et alLong-term Oxygen Treatment Trial Research Group. A randomized trial of long-term oxygen for COPD with moderate desaturation. N Engl J Med. 2016;375(17):1617–1627. - PubMed
  90. Kohara H, Ueoka H, Aoe K, et al. Effect of nebulized furosemide in terminally ill cancer patients with dyspnea. J Pain Symptom Manage. 2003;26(4):962–967. - PubMed
  91. Shimoyama N, Shimoyama M. Nebulized furosemide as a novel treatment for dyspnea in terminal cancer patients. J Pain Symptom Manage. 2002;23(1):73–76. - PubMed
  92. Wilcock A, Walton A, Manderson C, et al. Randomised, placebo controlled trial of nebulised furosemide for breathlessness in patients with cancer. Thorax. 2008;63(10):872–875. - PubMed
  93. Morelot-Panzini C, O'Donnell CR, Lansing RW, Schwartzstein RM, Banzett RB. Aerosol furosemide for dyspnea: controlled delivery does not improve effectiveness. Respir Physiol Neurobiol. 2018;247:146–155. - PubMed
  94. Abdallah SJ, Smith BM, Ware MA, et al. Effect of vaporized cannabis on exertional breathlessness and exercise endurance in advanced chronic obstructive pulmonary disease. A randomized controlled Trial. Ann Am Thorac Soc. 2018;15(10):1146–1158. - PubMed
  95. Tashkin DP. Vaping cannabis and chronic obstructive pulmonary disease. Ann Am Thorac Soc. 2018;15(10):1137–1138. - PubMed
  96. Ahmedzai SH, Laude E, Robertson A, Troy G, Vora V. A double-blind, randomised, controlled phase II trial of Heliox28 gas mixture in lung cancer patients with dyspnoea on exertion. Br J Cancer. 2004;90(2):366–371. - PubMed
  97. Haywood A, Duc J, Good P, et al. Systemic corticosteroids for the management of cancer-related breathlessness (dyspnoea) in adults. Cochrane Database Syst Rev. 2019;2: Cd012704. - PubMed
  98. Mularski RA, Munjas BA, Lorenz KA, et al. Randomized controlled trial of mindfulness-based therapy for dyspnea in chronic obstructive lung disease. J Altern Complement Med. 2009;15(10):1083–1090. - PubMed
  99. Mosher CE, Secinti E, Hirsh AT, et al. Acceptance and commitment therapy for symptom interference in advanced lung cancer and caregiver distress: a pilot randomized trial. J Pain Symptom Manage. 2019;58(4):632–644. - PubMed
  100. Peng CS, Baxter K, Lally KM. Music intervention as a tool in improving patient experience in palliative care. Am J Hosp Palliat Care. 2019;36(1):45–49. - PubMed
  101. Gallagher LM, Lagman R, Rybicki L. Outcomes of music therapy interventions on symptom management in palliative medicine patients. Am J Hosp Palliat Care. 2018;35(2):250–257. - PubMed
  102. Noseda A, Carpiaux JP, Markstein C, Meyvaert A, de Maertelaer V. Disabling dyspnoea in patients with advanced disease: lack of effect of nebulized morphine. Eur Respir J. 1997;10(5):1079–1083. - PubMed
  103. Bruera E, Sala R, Spruyt O, Palmer JL, Zhang T, Willey J. Nebulized versus subcutaneous morphine for patients with cancer dyspnea: a preliminary study. J Pain Symptom Manage. 2005;29(6):613–618. - PubMed
  104. Kallet RH. The role of inhaled opioids and furosemide for the treatment of dyspnea. Respir Care. 2007;52(7):900–910. - PubMed
  105. Masood AR, Reed JW, Thomas SH. Lack of effect of inhaled morphine on exercise-induced breathlessness in chronic obstructive pulmonary disease. Thorax. 1995;50(6):629–634. - PubMed
  106. Juan G, Ramon M, Valia JC, et al. Palliative treatment of dyspnea with epidural methadone in advanced emphysema. Chest. 2005;128(5):3322–3328. - PubMed
  107. Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trial. Lancet. 2010;376(9743):784–793. - PubMed
  108. Campbell ML, Yarandi H, Dove-Medows E. Oxygen is nonbeneficial for most patients who are near death. J Pain Symptom Manage. 2013;45(3):517–523. - PubMed
  109. Ferreira DH, Ekstrom M, Sajkov D, Vandersman Z, Eckert DJ, Currow DC. Extended-release morphine for chronic breathlessness in pulmonary arterial hypertension—a randomized, double-blind, placebo-controlled, crossover study. J Pain Symptom Manage. 2018;56(4):483–492. - PubMed
  110. Ferreira DH, Louw S, McCloud P, et al. Controlled-release oxycodone versus placebo in the treatment of chronic breathlessness—a multi-site randomised placebo controlled trial. J Pain Symptom Manage. 2019. - PubMed
  111. Ekström M, Nilsson F, Abernethy AA, Currow DC. Effects of opioids on breathlessness and exercise capacity in chronic obstructive pulmonary disease. A systematic review. Ann Am Thorac Soc. 2015;12(7):1079–1092. - PubMed
  112. O'Donnell DE, James MD, Milne KM, Neder JA. The pathophysiology of dyspnea and exercise intolerance in chronic obstructive pulmonary disease. Clin Chest Med. 2019;40(2):343–366. - PubMed
  113. Donesky D, Nguyen HQ, Paul SM, Carrieri-Kohlman V. The affective dimension of dyspnea improves in a dyspnea self-management program with exercise training. J Pain Symptom Manage. 2014;47(4):757–771. - PubMed
  114. Chlan L, Hertz MI. Integrative Therapies in Lung Health and Sleep. New York: Humana; 2012. - PubMed
  115. Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database Syst Rev. 2006;2. - PubMed
  116. Chlan LL, Weinert CR, Heiderscheit A, et al. Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support: a randomized clinical trial. JAMA. 2013;309(22):2335–2344. - PubMed
  117. Mularski RA, Reinke LF, Carrieri-Kohlman V, et al. An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis. Ann Am Thorac Soc. 2013;10(5):S98–S106. - PubMed
  118. Schneidman A, Reinke L, Donesky D, Carrieri-Kohlman V. Patient information series. Sudden breathlessness crisis. Am J Respir Crit Care Med. 2014;189(5):P9–P10. - PubMed
  119. Booth S, Johnson MJ. Improving the quality of life of people with advanced respiratory disease and severe breathlessness. Breathe (Sheff). 2019;15(3):198–215. - PubMed

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