Current opinion in supportive and palliative care
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Curr Opin Support Palliat Care · Jun 2011
ReviewApplicability and generalizability of palliative interventions for dyspnoea: one size fits all, some or none?
Determining which palliative interventions are appropriate within and between groups remains difficult because of the lack of prospective studies and heterogeneity in dyspnoea context, assessment and reporting. This review presents an evolution of dyspnoea theories, summarizes literature published during 2010 concerning intervention effectiveness between conditions and highlights the lag between emerging research evidence and dyspnoea assessments in clinical trials. ⋯ Multiple interventions exist for palliation of dyspnoea in different contexts. The majority of studies assessed emotional and behavioural consequences of dyspnoea rather than dyspnoea sensation (intensity, sensory quality, unpleasantness). As a more detailed understanding of the mechanisms leading to perceptions of dyspnoea evolve, a 'back to basics' strategy for clinical assessment might provide a means of determining which interventions can be generalized or are best suited to various forms of dyspnoea.
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Curr Opin Support Palliat Care · Jun 2011
ReviewUnderstanding mechanisms and documenting plausibility of palliative interventions for dyspnea.
To review the mechanisms for the perception of dyspnea and to consider the plausibility of interventions that palliate dyspnea after optimal treatment of the underlying disease. ⋯ Targets for palliating dyspnea in patients with advanced disease include sensory receptors within the lung/chest wall and the central nervous system. The opioid system plays an important role in palliating dyspnea. Both endogenous (β-endorphins) and exogenous (morphine) opioids modulate breathlessness.