Managing Dyspnea in End-of-Life Care

How people die remains in the memory of those who live.

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Dyspnea is a distressing condition where people face difficulty in breathing.

This condition causes severe discomfort, especially in terminally ill patients.

The Palliative Care Network of Wisconsin says that up to 90% of patients experience Dyspnea during the last three days of life.

This proves the need to create effective strategies to manage Dyspnea in end-of-life care.

It causes physical discomfort and creates a substantial emotional impact among patients. Feelings of isolation, anxieties about suffocation, loss of control, death, etc, become pretty prevalent, causing severe emotional distress.

Practical Methods to Manage Dyspnea

Dyspnea could be caused due to underlying medical conditions such as heart failure or Chronic Obstructive Pulmonary Disease (COPD).

However, it is essential to focus on the emotional and existential anxieties that aggravate the feeling of breathlessness.

1. Address the Root Cause: Medications like diuretics for heart failure, bronchodilators for COPD, etc, help treat the underlying medical conditions that cause Dyspnea. In some instances, oxygen therapy or non-invasive ventilation techniques can also help provide support.
2. Pharmacological Management: Opioids help manage pain in end-of-life care. These act on the central nervous system and reduce the perception of breathlessness. However, careful titration is a must to ensure that side effects such as drowsiness or respiratory depression are minimized.

Non-Pharmacological Interventions

1. Positioning: Elevating the head and upper body with pillows, specially designed wedges, etc., can help ease the breathing effort. This posture opens up the airways and reduces the diaphragm’s workload.
2. Relaxation Techniques: Guided meditation, breathing techniques, progressive muscle relaxation, and other techniques help reduce anxiety and the perception of breathlessness in patients.
3. Environmental Comfort Measures: It is essential to keep the patient in a cool, well-ventilated room with access to fresh air. Fans, humidifiers, etc., can also help create a more breathable and comforting environment for the patient.

Psychological and Emotional Support

Open and clear communication is essential not just for patients suffering from Dyspnea but for every end-of-life patient. Addressing anxieties, validating their feelings, and taking utmost care of their feelings are important to reduce the patient’s emotional turmoil.

You may also seek spiritual support from a chaplain if needed.

Not only loved ones but also healthcare professionals should actively listen to the patient’s concerns, ask open-ended questions, and explain things in lucid language.

It is crucial to understand the patient’s perception of Dyspnea, such as whether it is tightness in the chest, a feeling of suffocation, or rapid or shallow breathing.

This can help pinpoint the exact source of the problem and provide treatment plans accordingly.

Types of Dyspnea

1. Primary Dyspnea: Usually, it happens due to some underlying condition. Airflow obstruction or fluid buildup in the lungs can make breathing difficult in advanced COPD or congestive heart failure stages. Patients usually experience tightness in their chest, feel suffocated or have difficulty breathing even while they’re resting.
2. Secondary Dyspnea

• Pleural Effusion: At times, fluid accumulates in the space between the lung and chest wall, known as the pleural space. This restricts lung expansion and limits the amount of air intake per breath. It can cause serious Dyspnea and coughing among patients.
• Anxiety: End of life is associated with a lot of stress caused due to fear of death. And even mild anxiety can cause rapid, shallow breathing, which worsens the feeling of being suffocated.
• Metabolic Acidosis: The body becomes too acidic due to an imbalance in blood chemistry. This stimulates rapid, shallow breathing to expel carbon dioxide and return the body to a normal state. This can lead to Dyspnea, along with confusion and nausea.
• Muscle Weakness: Patients might develop a weakness in the respiratory muscles, which might cause difficulty in the contraction and expansion of the lungs. This leads to more breath intake per minute and causes shortness of breath.

Terminal Respiratory Patterns

Abnormal breathing patterns arise during the last stages of life. These may or may not be distressing for the patient.

• Cheyne-Stokes Respiration: This involves periods of rapid, deep breathing and then pauses in breathing, which may last for several seconds. The cycle then continues to repeat itself. Even though this might look alarming, it might not be distressful for the patient experiencing it.
• Agonal Respirations: Irregular and shallow gasps, accompanied by noisy breathing or even secretion in the airways. These are not a sign of suffering either.

The Role of Family and Loved Ones

Patients are bound to trust their families and be more comfortable around them.

Family members need to educate themselves about Dyspnea and its management, which can help them better manage it.

They should understand all the desired treatment options, potential side effects, the associated costs, etc. so that they can participate in the decision-making process along with medical experts and the palliative care team.

Indulging in simple acts of kindness, such as holding the patient’s hand, listening to their fears, and comforting them while they express their emotions, can make the patient feel loved and not alone.

Also, simple tasks such as getting dressed or eating often become difficult for Dyspnea patients. Here, family members should provide help at every step, which can help alleviate the burden of patients.

However, it is also essential for caregivers to take care of themselves, as these distressing times entail a lot of energy and mental strength, leading to fatigue. They should prioritize their well-being to ensure they are always able to help their loved ones. Sleeping for 6–8 hours, consuming healthy and nutritious food, engaging in social activities, etc, are a must for family members.

Yes, dyspnea creates several challenges for patients and their caregivers.

However, advancements in palliative care are helping address the common root cause.

Medical, emotional, spiritual, and psychological support, along with the love and warmth of family members, can help Dyspnea patients spend the rest of their lives with comfort.

We can help you, too. Get in touch today: https://endwellcare.life/