Dyspnea or breathlessness is a subjective symptom. Patients report they have difficulty breathing. It is essential to know if this breathless feeling is associated with severe anxiety or a physical cause (Fardy, 2016). According to Albert (2017), dyspnea can be caused by the following:


The estimated prevalence of breathlessness in advanced disease 





Heart disease


Chronic obstructive pulmonary disease


Chronic kidney disease


These are known physical causes of breathlessness in palliative care patients:

A useful tool for assessing dyspnea through observation is the Respiratory Distress Observation Scale https://pubmed.ncbi.nlm.nih.gov/20078243/. It contains eight variables: tachypnea, increased difficulty breathing, restlessness, and grunting, plus oxygen saturation levels.
Opioids are considered the medication of choice for the treatment of breathlessness. Oxygen therapy is only recommended for hypoxic patients. No evidence supports the improvement of breathlessness using oxygen if the O2 levels are in a normal range (Albert, 2017; Fardy, 2016).

Here are some recommended non-pharmacological interventions to manage breathlessness (Powell, 2014).

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Opioids are considered the medication of choice for the treatment of breathlessness.



Albert, R.H. (2017). End-of-life care: Managing common symptoms. American Family Physician. 95(6), 356-361.

Campbell, M. L., Templin, T. & Walch, J. (2010). A Respiratory Distress Observation Scale for Patients Unable To Self-Report Dyspnea. Journal of Palliative Medicine. 13(3), 285-290.

Del Fabbro, E., Dalal, S. & Bruera, E. (2006). Symptom control in palliative care—part iii: Dyspnea and delirium. Journal of Palliative Medicine. 9(2).

Fardy H. J. (2016). Oxygen therapy in palliative care. NPJ primary care respiratory medicine, 26, 15073.

Powell, B. (2014). Managing breathlessness in advanced disease. Clin Med (Lond). 14(3), 308–311.