Current opinion in supportive and palliative care
-
Curr Opin Support Palliat Care · Sep 2014
ReviewInhaled nebulized and intranasal opioids for the relief of breathlessness.
Inhaled nebulized and intranasal opioid administration is available with a proven short onset of action for the relief of pain. As breathlessness episodes are short, these routes of administration seem to be attractive for breathlessness management. This review describes the recent studies evaluating the effectiveness of inhaled nebulized and intranasal application of opioids for patients suffering from refractory breathlessness. ⋯ There is currently not enough evidence to support the use of inhaled application of opioids for the relief of breathlessness. There are no controlled trials assessing the efficacy and effectiveness of intranasal opioid application, but a pilot trial is underway to provide preliminary data.
-
Curr Opin Support Palliat Care · Sep 2014
ReviewCorrelates between basic science and therapeutic interventions: the theory and the practice.
To review the science of breathlessness and demonstrate how current therapeutic interventions for breathlessness target the known underlying mechanisms. ⋯ Therapies which aim to reduce the neural respiratory drive include oxygen, exercise and opioids. Interventions which aim to improve ventilation include breathing retraining and positioning. Modulation of respiratory afferent feedback may be achieved using chest wall vibration and fan therapy. Cognitive and behavioural therapies aim to modify the emotional response to breathlessness. Opioids have been shown to modulate breathlessness at the level of the corticolimbic system, as well as the brainstem. Further work is needed to identify other relevant neurotransmitter systems in order to explore new therapies.
-
Systemic opioids have the evidence to support their use in refractory dyspnea; however, the mechanisms of how they exert their effects are not fully understood. The relevance of peripheral mechanisms, in part, is still questioned, especially as a meta-analysis demonstrated no benefit from nebulized opioids. This might be related to the lack of standardization of the inhalation methods. There is a need to clarify whether peripheral opioid receptors may serve as the target for inhaled treatment and what are the potential peripheral mechanisms of opioids. ⋯ Research suggests that peripheral opioid receptors in lungs may be utilized as a target for therapeutic interventions. According to this hypothesis, to achieve breathlessness relief, opioids should be administered in close proximity to their receptors in the PNECs and sensory C-fibers of the bronchial epithelium.
-
Curr Opin Support Palliat Care · Sep 2014
ReviewBreathlessness in motor neurone disease: a review of the current strategies and gaps in the evidence.
This review on breathlessness and motor neurone disease (MND) is important, as palliative care teams are increasingly becoming involved in the complex care of these patients at an earlier stage in their illness. Subtle cognitive and behavioural changes with MND may make management more challenging. Breathlessness is a distressing symptom, impacting on both patients and carers. Assessment and expectant management of breathlessness improves the quality of life (QoL) and may minimize hospital admission. ⋯ Assessment of breathlessness and its successful management improves the QoL of patients with MND. Opioids in titrated doses may play a role in this. NIV improves survival in patients with respiratory failure with minimal or no bulbar symptoms and should be offered when appropriate. Preemptive education improves the uptake and understanding of the role of NIV.
-
Curr Opin Support Palliat Care · Sep 2014
ReviewSupportive and palliative care for patients with chronic mental illness including dementia.
People with preexisting mental illness are known to have difficulty accessing healthcare services including palliative care and people with dementia have similar issues accessing palliative care. ⋯ Urgent research is required as to how support for people with preexisting mental illness who require palliative care can be improved--excellent liaison between mental health and palliative care teams is essential. There is much research on palliative care needs for people with dementia but an apparent lack of innovative approaches to care including care of people within their family home.