Managing Dyspnea in Lung Cancer

November is Lung Cancer Awareness Month and Dr Bhaumik Shah, Medical Oncologist, provides an update for General Practitioners on Managing Dyspnea in Lung Cancer.

Dyspnea is a common and distressing symptom for patients with advanced lung cancer. A systemic approach to management can be very rewarding to a GP. The management would require thorough assessment of underlying causes for the symptom. The management might require multidisciplinary coordination. Some of the interventions are easy to manage in community and some of them need in-hospital short stay.

Look for reversible causes:

Possible cause Management
Pleural effusion Drain or pleurodesis
Pericardial effusion Drain or window
Ascites Drain
Chest infection Antibiotics
Anemia Transfuse with RBC
Pulmonary embolism Anticoagulation
Heart failure Diuresis and optimise meds
Lymphangitis carcinomatosis Prednisolone or dexamethasone
Superior vena cava obstruction Radiotherapy
Bronchial compression Radiotherapy
COPD Optimise inhalers

For no reversible causes:

If not hypoxic:

  • Better flow of air with a handheld or table fan next to bed to stimulate trigeminal nerve on face.
  • If anxiety is worsening dyspnea – Lorazepam sublingual (works quickly)
  • Refractory dyspnea – low dose opioids eg 2.5-5 mg liquid morphine prn. Can avoid respiratory depression and toxicities.
  • Breathing exercises with help of physiotherapist

If hypoxic:

  • Consider O2 concentrator at home on hire and some O2 cylinders for going out
  • Seek advice from oncologist or palliative care team.

Additional resources:

 

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Dr Bhaumik Shah
MBBS, MD, FRACS 

Dr Bhaumik Shah’s special interests include:

  • Supportive care
  • Cancers of the:
    • breast
    • lung
    • gastrointestinal
    • prostate
    • testicular
    • bladder
    • kidney
    • brain
    • head and neck

To arrange an appointment with Dr Bhaumik Shah, please contact:

Moreland Orthopaedics and Specialists
255 Moreland Road Coburg VIC 3058

P 03 9416 0003
F 03 9417 0009
E reception@drbhaumikshah.com
 

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