There is information on CareSearch relating to dyspnoea, breathlessness and related topics of dysphagia and aspiration.

Dyspnoea is a subjective experience and reported difficulty may or may not relate to oxygen saturation levels. It is a symptom commonly experienced at the end-of-life. It may be associated with heart failure, lung disease or cancer. It can also occur when there is no apparent diagnosis of cardiac or respiratory illness. Dyspnoea at the end-of-life can be difficult to relieve. [1]

Dyspnoea reduces quality of life and it affects emotional, spiritual and physical wellbeing. There are many different tools to assess dyspnoea but due to the complex nature of this symptom, not one tool can be recommended. Objectively evaluating the effects of care interventions without an appropriate tool is difficult.

Asking residents who can self-report, if they are experiencing breathing difficulties and how that is affecting them is the best guide. Using a simple Numerical Rating Scale (NRS) or Visual Analogue Scale (VAS) is recommended for palliative residents who can self-report. There is a newly developed tool for use with residents who cannot self-report, the Respiratory Distress Observation Scale (RDOS), which may be useful in these cases. [2]

Recommendations for managing dyspnoea at the end-of-life include:

  • care based on a comprehensive assessment of resident and symptom distress
  • discussion with resident, family and health care team to agree goals of care
  • opioids can reduce symptoms and improve quality of life
  • manage related issues such as:
    • fatigue
    • depression
    • anxiety
    • emotional issues.
  • some residents may find relief from a fan directing fresh air onto their face
  • some residents may be more comfortable if supported to sit upright or to lean on a supportive table: A recliner type chair or electric bed with backrest and knee break may be more comfortable and reduce shear forces.
  • spacing care activities across the day may be less tiring than trying to attend to all care at one time.
  • Useful Tip

Residents with dyspnoea tire quickly and residents who are easily fatigued often complain of dyspnoea. Organising all equipment and staff prior to commencing care procedures can shorten the time taken for care and reduce the impact on the resident.

Related Evidence

RAC PubMed Breathlessness Search

  1. Currow DC, Smith J, Davidson PM, Newton PJ, Agar MR, Abernethy AP. Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study. J Pain Symptom Manage. 2010 Apr;39(4):680-90.
  2. Mularski RA, Campbell ML, Asch MS, Reeve BB, Basch E, Maxwell TL, et al. A review of quality of care evaluation for the palliation of dyspnea. Am J Respir Crit Care Med. 2010 Mar 15;181(6):534-8. Epub 2010 Jan 7.

Palliative Care Network of Wisconsin Fast Facts:

Last updated 14 February 2017