Overview of breathlessness in palliative care

Breathlessness is a subjective experience of difficulty breathing. Breathlessness affects patients in different ways; it involves a complex interaction between physical, psychological, social and existential factors. The experience of breathlessness depends on:

• the patient’s coping strategies (engaged or disengaged)
• the patient’s health-seeking behaviours (self-management or crisis healthcare–seeking behaviour)
• the management and support provided by healthcare professionalsHutchinson, 2018.

The Palliative Care guidelines provide management advice on:

• chronic breathlessness—resulting from a chronic condition (eg cancer, chronic obstructive pulmonary disease, interstitial lung disease, heart failure, motor neurone disease) and persisting despite optimal management of the cause, reducing quality of lifeJohnson, 2017. Patients with chronic breathlessness can experience acute exacerbations (eg acute-on-chronic breathlessness, breathlessness on exertion). Breathlessness often occurs throughout the disease trajectory and increases towards the end of lifeBausewein, Schunk, , 2018
• severe acute breathlessness (breathlessness crisis)—a medical emergency characterised by sustained and severe breathing discomfort at rest. It can occur suddenly or as an acute worsening of chronic breathlessness (acute-on-chronic breathlessness)Hutchinson, 2018.