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: