Current opinion in supportive and palliative care
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Breathlessness remains a frequent and burdensome symptom for individuals with life-limiting symptoms in both malignant and nonmalignant settings. As oxygen therapy is frequently given as part of the management of breathlessness and is associated with costs, treatment burden and potential dangers, it is timely to review the efficacy and appropriateness of palliative oxygen therapy. ⋯ On the basis of the findings of this review, the routine use of palliative oxygen therapy without detailed assessment of pathogenesis and reversibility of symptoms cannot be justified. Promoting self-management strategies, such as cool airflow across the face, exercise and psychological support for patients and carers, should be considered before defaulting to oxygen therapy. If palliative oxygen therapy is considered for individuals with transient or mild hypoxaemia, a therapeutic trial should be conducted with clinical review after 3 days to assess the net clinical benefit and patient preference.
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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.