Dyspnoea: Assessment and Management

Have you ever felt breathless after climbing a flight of stairs? You probably feel an uncomfortable sensation of breathing! How do we then assess and manage dyspnoea, a common symptom experienced by palliative care patients? Watch on to find out more!


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Recap 📝
Dyspnoea = breathlessness: a subjective sensation of an uncomfortable awareness of breathing. It is a frequent symptom, occurring in 50-70% of dying patients.

Causes of Dyspnoea:
Physical illnesses e.g. pneumonia, chronic obstructive pulmonary disease (COPD), and organ failures.
Psychological issues e.g. anxiety, fear, and depression.

Assessment of Dyspnoea:
Getting patients to self-report is the best way to assess dyspnea as it is a subjective symptom.

1. Numerical rating scale.
The patient rates dyspnoea on a scale of 0 (no breathlessness) to 10 (worst breathlessness).

2. Respiratory Distress Observation Scale (RDOS)
RDOS comprises the following components:
• Heart rate per minute (HR/min)
• Respiratory rate per minute (RR/min)
• Restlessness, where the patient moves around non-purposefully.
• Abnormal breathing patterns such as the patient's abdomen moving in when breathing in
• Use of accessory muscles
• Grunting when the patient breathes out
• Nasal flaring where the patient's nostrils are widened during breathing
• Look of fear such as eyes wide open, facial muscles tense, etc.

Non-pharmacological interventions:
• Modifying activity
• Modifying environment
• Providing touch and comfort.

Pharmacological measures, there are 2 main treatment goals:
• To look for reversible causes and treat the underlying conditions, for example providing antibiotics for lung infections.
• To relieve dyspnoea by using opioids such as morphine and fentanyl and/or benzodiazepines.

Animation transcript: https://bit.ly/3lnk1jr

References
1. Booker R. Causes and management of chronic breathlessness in adults. Nurs Times. 2004;100:46-7, 49-50.
2. Lanken PN, et al. An official American Thoracic Society clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical Illnesses. American Thoracic Society Documents. Am J Respir Crit Care Med. 2008;177(8):912-27.
3. Campbell ML, Templin T, Walch J. Patients who are near death are frequently unable to self-report dyspnea. J Palliat Med. 2009;12:881–884.
4. Gift AG, Narsavage G. Validity of the numeric rating scale as a measure of dyspnea. Am J Crit Care. 1998;7(3):200-204.

Content experts: Dr. Ho Peiyan and Dr. Laurence
Video producer: Perry Lee
Voiceover: Henry Kong
This video is done in collaboration with GERI Institute - https://www.geri.com.sg/

All rights are reserved to GeriCare and there should not be any reproduction, publication, or adaptation to any part of the video content without prior approval from GeriCare.
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