Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Dec 2009
Review Case Reports[Nasal application of fentanyl citrate as symptom control against breathlessness in palliative care--overview and case report].
Severe dyspnoea is the most threatening symptom of the dying and one of the main reasons for undesirable hospitalisation in end of life. Especially in home care there is a need for a noninvasive, safe and highly effective method for symptom control. Fentanyl is an appropriate drug because of its fast onset and short duration of action. ⋯ Clinical experience let us assume that intranasal administration against dyspnoea is not inferior to the intravenous symptom control. In ambulant care caused by the use of the caring relatives or the patients themselves non-invasivity is a great advantage. Prospective studies are in need to prove the method.
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Wien Med Wochenschr · Dec 2009
ReviewPathophysiology and diagnosis of dyspnea in patients with advanced cancer.
The reported prevalence of dyspnea in patients with various cancers ranges from 19% to 64%. For optimal clinical management of dyspnea in cancer patients, accurate diagnosis of the underlying cause and thorough understanding of the pathomechanisms of dyspnea seems mandatory. ⋯ These should be performed immediately to enable quick treatment decisions. In addition, self assessment of the intensity of dyspnea by the patient may help to assess patient's needs as soon as possible.
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Wien Med Wochenschr · Dec 2009
ReviewManagement of dyspnea in patients with chronic obstructive pulmonary disease.
A progressive and debilitating illness, chronic obstructive pulmonary disease (COPD) has major worldwide impact. In addition to the care for underlying causes of disease, COPD treatment involves palliative intervention to address associated symptoms; in later stages of disease, when the underlying disease has been maximally treated, symptom management assumes primacy as the goal of care. Dyspnea is the most distressing symptom experienced by COPD patients. ⋯ Numerous pharmacologic and non-pharmacologic interventions are available to achieve these goals, but supporting evidence is variable. This review summarizes options for managing refractory dyspnea in COPD patients, referring to the available evidence and highlighting areas for further investigation. Topics include oxygen, opioids, psychotropic drugs, inhaled frusemide, Heliox28, nutrition, psychosocial support, and breathing techniques.
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Wien Med Wochenschr · Dec 2009
Case ReportsOpioids for symptomatic therapy of dyspnoea in patients with advanced chronic heart failure--is there evidence?
In times of reduced mortality from myocardial infarction and ageing of the population, the number of patients suffering from chronic heart failure continues to rise. In spite of optimal cardiological treatment, many patients suffer from dyspnoea. The use of commonly used drugs in palliative care such as opioids for the relief of dyspnoea is uncommon in this group of patients. ⋯ Three randomised controlled trials with opioids could be identified. The quality of the identified studies does not support the avoidance of the use of opioids in patients with chronic heart failure to relieve dyspnoea. But further studies are recommended to support the use of opioids in patients with chronic heart failure for relief of breathlessness to improve the quality of life of this growing population.