The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

Chapter 6.26 picasPulmonary SymptomsConnie J Beehler, MDINTRODUCTION■ This chapter will focus on basic methods of treating the suffering and distress caused bycommon pulmonary symptoms in AIDS patients. The approaches offered below are useful inrelieving discomfort, even when the underlying disease is not treatable. The first part of thischapter will explore issues related to end-of-life decisions in the care of patients who have pulmonarydiseases. The second part will address treatment for specific pulmonary symptoms.HIV-positive individuals are at risk for a variety of disease processes that compromise lung functionor cause respiratory symptoms (see Table 6-1). In fact, pulmonary manifestations of AIDSare among the most frequent causes of death in HIV disease. Symptoms associated with lunginvolvement can be very disturbing to patients. When symptoms include severe air hunger oreven a sensation of suffocation, these can lead to escalating feelings of fear, anxiety, and panic.Relief of symptoms can make a great deal of difference in the quality of life for people with HIV,even when the underlying disease is progressing.VITable 6-1: Presenting Symptoms and Radiographic Findingsof Common Pulmonary Manifestations of AIDSLymphoma Pneumocystis Bacterial Tuberculosisor Kaposi’s Carinii PneumoniaSarcoma PneumoniaBullae/cavities ■ ■ ■Chest Pain ■ ■ ■ ■ ■ ■ ■ ■Desaturation ■ ■ ■ ■ ■Dyspnea on Exertion ■ ■ ■ ■ ■ ■ ■Fever ■ ■ ■ ■ ■ ■ ■Hemoptysis ■ ■ ■ ■ ■ ■Infiltrates ■ Bilateral/Patchy Unilateral/lobar ApicalNight Sweats ■ ■ ■ ■ ■ ■ ■Nodules ■ ■ Embolic ■ ■Onset of Symptoms Gradual Weeks /gradual Acute Acute or gradualPleural Effusion ■ ■ ■ Rare ■ ■ ■Productive Cough ■ ■ ■ ■ ■Key: ■ Occurs occasionally■ ■ Occurs commonly■ ■ ■ Occurs very frequentlySource: Carla Alexander, MDU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 135