Guidelines for a Palliative Approach in Residential Aged Care

6.12 DYSPNOEA
Dyspnoea is defined as an awareness of uncomfortable breathing that can seriously affect quality
of life and is frequently associated with the end stage of various diseases, such as cancer, cardiac
failure, obstructive airway disease, and neurodegenerative disorders [160] (Level II). The experience
of dyspnoea comes from multiple physiological, psychological, social and environmental factors
that can result in secondary physiological and behavioural responses [239] (Level II). The experience
of dyspnoea (i.e. breathlessness) may not be directly attributed to the disease, because other factors
such as anxiety exacerbate the symptoms [240] (Level IV). Dyspnoea directly affects all aspects of a
resident’s activities of daily living, limits mobility, increases anxiety, and can leave residents feeling
fearful and socially isolated [239] (Level II). It can also be a sign of a deteriorating condition in
residents receiving a palliative approach.
Dyspnoea triggers panic, and panic exacerbates dyspnoea, so the pattern becomes cyclical. The
evidence suggests that 70% of people receiving a palliative approach experience dyspnoea in
the last six weeks of life [241] (Level QE). In the terminal phase of ageing and/or illness, fear of
suffocation may be the most troubling symptom. This may significantly affect the ultimate
place of death [240] (Level IV).
Dyspnoea may also be a distressing and frightening symptom for the family. Advice and
support regarding the management of dyspnoea [239] (Level II) from the aged care team, as well
as reassurance and a calm presence, can help lessen the anxiety experienced by the resident
and their family. It is important to note that even after a resident’s dyspnoea has been relieved
family members might require more attention from the aged care team [241] (Level QE). Family
members’ perceptions of a resident’s suffering can influence how the family makes meaning of,
and come to terms with, the dying experience of the resident.
6.12.1 Assessment
A complete history and physical examination will illicit enough information to determine a
diagnosis of dyspnoea in most people. The history should cover factors that are likely to have
influenced the severity of the symptom [239] (Level II), including pre-existing illnesses (such as
COPD), exacerbating factors (such as anaemia or profound anxiety) and additional factors
(such as pulmonary embolism, infection or left ventricular failure).
The resident’s perception of dyspnoea can also be measured using a visual analogue scale, with 0
being no shortness of breath and 10 being the worst shortness of breath. This measure provides
the aged care team with some understanding of how distressing dyspnoea is for the resident.
6.12.2 Management
The aim of managing dyspnoea for a resident receiving a palliative approach is to minimise
suffering and not to prolong life [241] (Level QE). If there are specific causes of dyspnoea
these should be treated in accordance with the resident’s preferences. These causes may
include cardiac failure, pulmonary embolus, infection, anaemia, arrhythmia, pleural effusion,
bronchospasm or pneumothorax. Managing the symptoms of dyspnoea should include
supportive care for the resident, family members and their carers, and the use of medications,
which may include opioids. A comprehensive plan of care, including ready access to appropriate
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