Treatment of Dyspnea

Many diseases that cause dyspnea can be treated – if possible, such treatment is naturally the best thing to do. However, in many cases the disease cannot be fully cured, and shortness of breath remains a daily problem that limits activities and causes discomfort and suffering.  Although research in this area is not as advanced as in pain, there are some options that many people have found helpful.  Finding the right course of action for your individual problem may not be easy.  The place to start is with a board certified pulmonary physician.  Unfortunately, there are only two clinics in the US that specialize in the diagnosis and treatment of difficult dyspnea cases – see this link.  There are other physicians competent in dyspnea treatment that may be able to help, but there is no special certification or national register to help you find the right one.

 

Some of the treatment options you and your doctor may wish to explore are listed below – some of these treatments have not been scientifically evaluated, but there are reports from patients who claim they have helped – we will note these as “unproven”.  One obvious action you can take for yourself is to stop smoking if you smoke.  This is not an easy task, but online and local smoking cessation help programs are widely available and can be effective. (Try googling quit smoking programs in your city) Helpful information on quitting is available at this government website: http://www.smokefree.gov/

Drug treatment

Bronchodilator Drugs (e.g., Albuterol, Serevent, Atrovent, Spiriva).  These drugs are only effective in cases where dyspnea arises partly from contraction of the smooth muscle that narrows the airways of the lung. (called bronchospasm or bronchoconstriction)    Individuals with Asthma and Chronic Obstructive Lung Disease (emphysema and chronic bronchitis) are often treated with these medications, which take effect rapidly (within minutes).

Anti-inflammatory Drugs. In asthma, chronic obstructive lung disease (COPD), and interstitial lung disease there is inflammation of the airways, which causes them to swell and narrow the air passages.  Part of the treatment of these conditions is to reduce the inflammation with inhaled drugs or oral medications that contain corticosteroids and other agents that reduce the inflammation and swelling.  These drugs act slowly, over the course of days, to help prevent attacks and reduce shortness of breath.

Opiates. Narcotic drugs like morphine can be very helpful in some circumstances to reduce dyspnea, for example in very ill cancer patients.  These drugs have obvious disadvantages in many cases, but when dyspnea is troublesome even when the patient is resting, this option should be considered.

Anti-anxiety drugs. In those cases where dyspnea is caused or made worse by anxiety, calming drugs called anxiolytics may be helpful.  Non-pharmacological approaches may be just as helpful in many cases, and have fewer undesirable side effects.

Supplementary oxygen. Supplementary oxygen (extra oxygen administered through a mask or nasal ‘prongs’) is currently prescribed only on the basis of physiological measurements that indicate low oxygen in the blood.  The patients who fit the current criteria for oxygen prescription generally report that the oxygen reduces their shortness of breath.  Some patients whose physiological measurements do not indicate significantly low oxygen have obtained supplementary oxygen (the main issue here is insurance coverage); some of these patients report that the oxygen does reduce their shortness of breath, but there is no definitive scientific data to confirm this. Although people who are short of breath usually say they feel as though they are not getting enough oxygen, there are causes of dyspnea that do not involve low oxygen levels in the blood.

 

Treatment without drugs

Pulmonary rehabilitation.  Pulmonary rehab programs generally involve a structured exercise program with other adjunct therapies such as retraining the breathing muscles and teaching new breathing patterns.  These methods are helpful to many patients, even when the underlying disease process cannot be reversed.  These programs are widespread in the US – you can find one near you using Google (key words ‘pulmonary rehabilitation’ and your city).

The links below provide more information and also can help direct you to a program.

The American Thoracic Society’s information on pulmonary rehab (ATS is a leading scientific and clinical society for pulmonary medicine)

The US Government guidelines on pulmonary rehab

The American Association for Cardiovascular and Pulmonary Rehabilitation

Yoga. Yoga and other alternative breathing techniques have been reported to aid some patients with dyspnea. There is no solid scientific evidence that they help, although a scientific study is underway at the University of California, San Francisco.  There are no standardized practice guidelines for these alternative therapies, thus we suggest you consult your physician to be sure that the program you have chosen does not contain components that could be hazardous to you.  If it is safe and it helps you that’s all that matters.  Our own dyspnea clinic has the capacity to provide yoga breathing training. 

Information about the yoga study at UCSF

Cool Breeze.  Cool air blowing across the face is often surprisingly effective in reducing dyspnea.  There is published scientific evidence for this treatment, which can be effective even in patients with terminal illness.  The cost and side effects are minimal, of course, so we highly recommend that you try it.

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