Breathlessness is the subjective sensation of discomfort with breathing and is a common cause of major suffering in people with acute, advanced and terminal disease. Treatment of underlying causes of dyspnoea should be considered and optimised where possible.
The UK Association for Palliative Medicine (APM) have provided some strategies for managing breathlessness in End-of-Life care in Covid-19 situations:
Check for Reversible causes
Lots of conditions can cause severe distress / breathlessness towards the end of life, including advanced lung cancer, superior vena cava obstruction, lymphangitis carcinomatosa, COPD, asthma, etc. For instance, always consider medication that may be contributing to worsening breathlessness, such as NSAIDs with someone who has a background of asthma.
Patient positioning, relaxation techniques, cooler room temperature and cooling the face by using a cool flannel or cloth can be very effective at reducing the sensation of breathlessness. Portable fans, although effective, have been linked to cross infection and are not advised during the COVID-19 pandemic.
Patients with COVID-19 symptoms, especially breathlessness, who are not expected to survive their illness often deteriorate quickly over a short period of time. As a result, they may need higher starting and maintenance doses of opioids / anxiolytics for breathlessness and associated fear/anxiety. Locate the suggested doses for mild/ moderate breathlessness, and severe breathlessness in the APM guideline attached below. Discuss with your colleagues and also run it by your local palliative care team.