Clinical review

ABC of palliative care: Breathlessness, cough, and other respiratory problems

	Introduction

Respiratory problems are common in patients with advanced incurable disease. This article describes palliation of adult patients with malignant disease, but the principles can be applied to many types of non-malignant disease.

A detailed history, examination, and appropriate investigations are needed to establish the most likely cause of any symptom. The history should cover factors that influence the severity of the symptom, including pre-existing diseases (such as chronic obstructive pulmonary disease, which is relatively common in patients with lung cancer), exacerbating factors (such as anaemia, ascites, or profound anxiety), and additional factors (such as pulmonary embolism, infection, or left ventricular failure). All of these will influence management.

	Breathlessness

Breathlessness has non-physical as well as physical aspects and, like pain, can be defined by what a patient says it is. It is an unpleasant sensation of being unable . . . [Full text of this article]

General principles of managing breathlessness

Management
Therapeutic options for specific situations

Oxygen
Choices of anxiolytic drug for treating breathlessness

Benzodiazepines
Opioids
Advice to patient about "panic attacks"

Common causes of cough

Other drugs

	Cough

Management
Classification of types of cough

Pharmacological agents that inhibit cough

Therapeutic options in managing productive cough

	Haemoptysis

Therapeutic options for haemoptysis

Management

	Stridor

	Pleural and chest wall pain

	Conclusion

	Notes

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Relevant Article

Primary care and palliative care

Daryl Freeman and David Price
BMJ 2006 333: 188-190. [Extract] [Full Text] [PDF]

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