GuidelinesEML (Adult Hospital STG)
Respiratory Conditions
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
For Coronavirus Disease-19. See PHC Infections and related conditions: COVID-19: CORONAVIRUS DISEASE-19.
DYSPNOEA
R06.0+ (Z51.5)
DESCRIPTION
- Dyspnoea is the subjective unpleasant sensation of being unable to breathe adequately (breathlessness).
- Dyspnoea is a complex multidimensional symptom with physical, psychological, and emotional dimensions, especially anxiety.
- The intensity of dyspnoea is generally not related to the oxygen saturation.
- Look for reversible causes, e.g. infection, pulmonary embolism, pleural effusion, bronchospasm and anxiety.
- The aim should always be to address the cause. However, in end stage disease, symptomatic treatment is indicated.
GENERAL MEASURES
- Ideally, include a physiotherapist and occupational therapist for pulmonary rehabilitation and to teach patients pursed lip breathing, pacing of activities, relaxation techniques, and positioning.
- The use of a fan may reduce the sensation of dyspnoea.
- Treat the underlying cause (e.g. antibiotics for underlying respiratory infection) wherever possible.
MEDICINE TREATMENT
- Morphine syrup, oral.
- Starting dose: 2.5-5 mg, 4 hourly as required, titrating up slowly.
- In renal failure: start at 1-2 mg and observe patient closely before titrating up as required.
Dyspnoea associated with hypoxaemia
- Oxygen.
RESPIRATORY SECRETIONS
R06.0 + (Z51.5)
DESCRIPTION
- Excessive respiratory tract secretions (also referred to as death rattle), is used to describe a rattling noise produced by accumulated secretions in the airway which oscillate in time with inspiration and expiration.
- Generally, respiratory secretions occur in patients who are extremely weak and close to death.
GENERAL MEASURES
- Change position of the patient.
- Explain to caregivers and relatives that the patient is not distressed by the secretion. Patients are not conscious that they are unable to clear secretions.
- Minimal oropharyngeal suctioning is required.
MEDICINE TREATMENT
- Hyoscine butylbromide, SC/IM, 20 mg.
- Increase dose to effect to maximum of 120 mg.
LoE:IVbxxviii
Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_07 November 2024
Chapter 24: Medicines used in Palliative Care_24.4 Respiratory Conditions