Current opinion in supportive and palliative care
-
Curr Opin Support Palliat Care · Jun 2010
ReviewManagement of dyspnea in advanced lung cancer: recent data and emerging concepts.
One of the most common symptoms for lung cancer patients, dyspnea, can seriously impact patients' quality of life. ⋯ This study reviews several interesting advances in the area of dyspnea with respect to symptom assessment and management.
-
Curr Opin Support Palliat Care · Jun 2010
ReviewContemporary issues in refractory dyspnoea in advanced chronic obstructive pulmonary disease.
Relieving dyspnoea when chronic obstructive pulmonary disease (COPD) no longer responds to disease-modifying therapy is challenging, with limited evidence to provide guidance. This review highlights recent advances that further our understanding and management of refractory dyspnoea in COPD, focusing on interventions that are considered beyond the conventional treatment of airflow obstruction/hyperinflation. ⋯ Improved understanding of the nature of dyspnoea in advanced COPD, advances in symptom mapping and noninvasive ventilatory support along with the potential of novel treatments offer hope that we can improve the management of refractory dyspnoea in COPD. Where evidence is lacking, we outline options that merit further evaluation.
-
Curr Opin Support Palliat Care · Jun 2010
Editorial ReviewThe dyspnea target: can we zero in on opioid responsiveness in advanced chronic obstructive pulmonary disease?
Despite recognition that opioids alleviate dyspnea in chronic obstructive pulmonary disease, many clinicians remain reluctant to use them outside of the final days of life. This article defines the term 'opioid responsiveness' as it pertains to dyspnea, and poses that it may be possible to predict more accurately the patients with chronic obstructive pulmonary disease and refractory dyspnea who might benefit from opioid treatment for either short-term use during episodes of dyspnea crisis or for long-term use for chronic dyspnea on minimal exertion. ⋯ The 'dyspnea target' or similar conceptual models that attempt to predict how specific aspects of dyspnea may affect response to treatments offer clinicians the potential to more effectively target interventions. The model is presented in its theoretical stage in order to stimulate further discussion and research in an area of current interest.
-
Curr Opin Support Palliat Care · Jun 2010
ReviewThe management of dyspnoea in chronic heart failure.
To identify current management options for dyspnoeic people with chronic heart failure (CHF). ⋯ Better standardization of dyspnoea outcome measures should help comparison of future trials. Optimization of diuretic therapy and attempted correction of neurohormonal disturbance in CHF remain the therapeutic targets for the underlying cause in dyspnoea management.