Dyspnoea

 

 DO

•  In children between 6 and 18 years of age, use a VAS or NRS scale to estimate the degree of dyspnoea or evaluate interventions.
• In children under 6 years of age or those with (severe) intellectual disabilities, ask representatives (parents and caregivers) to use a VAS or NRS scale to estimate the degree of dyspnoea or evaluate interventions.

• The following additional testing if it has therapeutic implications: 
  • Measurement of respiratory rate, oxygen saturation using pulse oximeter or the number of words that can be said on one breath.
  • Laboratory examination (haemoglobin, blood gas).
  • Additional X-ray examination, pulmonary function tests, bronchoscopy.

 Consider

 

• In case of dyspnoea due to growth of primary tumour, pleural fluid or metastases, consider radiotherapy or chemotherapy.
• In cases of local airway obstruction, consider tracheotomy, stent placement, or in specific cases, intraluminal treatment (laser, cauterisation).
• Consider treatment of infection or other comorbidities such as asthma, arrhythmias, reflux, drainage of fluid collections in pleura, pericardium or peritoneum, pneumothorax.
• In case of anaemia, consider blood transfusion at Hb < 5 mmol/l (see: erythrocyte transfusion - hematologic manifestations).

 DO

• Provide information and advice on breathing exercises and other physical therapy techniques (see also: Coughing - physical therapy techniques for sputum mobilisation). 

• Consider employing a physical therapist to apply physical therapy techniques, such as breathing exercises and alternating positions (see also: Coughing - physical therapy techniques for sputum mobilisation).

 Consider

• In cases of dyspnoea due to Cystic Fibrosis, consider non-invasive ventilation.

 Consider

• Consider the use of a 'hand-held' fan to cool the face.

 Consider

• Consider administering oxygen as a trial treatment. Stop administering oxygen if it does not work.

 DO

•  Create a calm environment.  

• Consider bringing in experts for self-hypnosis.
• Consider relaxation and distraction techniques and the use of comfort talk.

 
 DO

• Give fentanyl nasal spray intranasally for rapid treatment and anxiety reduction.
• Start morphine orally, intravenously, or subcutaneously if the shortness of breath causes discomfort.

• Consider lorazepam or midazolam (in combination with morphine) to reduce perceived discomfort, especially if anxiety is also present.

 
 Consider

• In cases of dyspnoea arising from airway swelling, atelectasis or broncho-obstruction, consider dexamethasone, other steroids, pulmonary dilators or mucolytics.

 Consider

• In terminally ill children with refractory dyspnoea, consider palliative sedation (see: palliative sedation).

 
 DO

• Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.