Dyspnoea
Respiratory Conditions
R06.0 + (Z51.5)
DESCRIPTION
Dyspnoea is the subjective, unpleasant sensation of being unable to breathe adequately (breathlessness). Dyspnoea is a complex symptom which can be caused or exacerbated by physical, psychological, and emotional factors. The intensity of dyspnoea is not related to the oxygen saturation. In the palliative care patient fluid overload is a potential cause of dyspnoea.
LoE:IIIb19
The aim should always be to address the underlying cause. However, in end stage disease it may not be possible to resolve dyspnoea. Therefore, symptomatic treatment is indicated in addition to treating the cause.
In children dyspnoea is often evidenced by difficulty talking or feeding, or restlessness.
GENERAL MEASURES
If available refer to a physiotherapist and occupational therapist for pulmonary rehabilitation, and to teach patients pursed lip breathing, pacing of activities, relaxation techniques and positioning.
A fan might reduce the sensation of dyspnoea.
Where possible treat the underlying cause e.g. antibiotics for underlying respiratory infection.
MEDICINE TREATMENT
Adults
LoE:IIIb20
- Morphine solution, oral (Doctor initiated).
- Starting dose: 2.5–5 mg, as required 4 hourly, titrating up slowly
- In renal failure: start at 1-2 mg and observe patient closely before titrating up as required.
LoE:IVb21
Children
- Morphine solution, oral (Doctor initiated).
- Starting dose:
- 0–1 month of age: 0.05 mg/kg 6 hourly.
- ≥ 1–12 months of age: 0.1 mg/kg/dose 4 hourly.
- ≥ 12 months of age: 0.2–0.4 mg/kg/dose 4 hourly.
LoE:IVb22
REFERRAL
- Dyspnoea associated with hypoxia for consideration of home-based oxygen.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 22: Medicines Used in Palliative Care_22.4 Respiratory Conditions_22.4.1 Dyspnoea