This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (22)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Oncology  • Lung Cancer  • Pulmonary Diseases  • Pulmonary Diseases, Other  • Perspectives on Care at the Close of Life  • Gastroenterology  • Liver/ Biliary Tract/ Pancreatic Diseases  • Genetics  • Genetic Disorders  • Alert me on articles by topic  Social Bookmarking   What's this?

"Once I Lose It, It's Kind of Hard to Catch It . . . "

John M. Luce, MD; Judith A. Luce, MD

JAMA. 2001;285:1331-1337.

Dyspnea is a common problem among patients with interstitial fibrosis, lung cancer, cystic fibrosis, and chronic obstructive pulmonary disease. The slow but steady progression of such diseases, often punctuated by acute exacerbations or secondary illnesses, can lead to decision-making dilemmas among patients and their caregivers, such as when to accept mechanical ventilation, when to forgo aggressive therapies, and when to make formal end-of-life care plans. Two cases, a 74-year-old woman with dyspnea secondary to emphysema and a 65-year-old woman with recurrent lung cancer and severe exertional fatigue and dyspnea, illustrate how dyspneic patients approaching the end of life can be evaluated and treated. Four management strategies for dyspnea are discussed: reducing ventilatory impedance, reducing ventilatory demand, improving respiratory muscle function, and altering central perception. Physicians should encourage end-stage lung disease patients and their families to discuss issues such as hospitalization and mechanical ventilation, to prepare advance directives, and to participate in a plan to manage their dyspnea.

Author Affiliations: Department of Medicine, University of California, San Francisco and San Francisco General Hospital.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

March 14, 2001
JAMA. 2001;285(10):1373-1374.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Nonpharmacological treatment and relief of symptoms in COPD
Clini and Ambrosino
Eur Respir J 2008;32:218-228.
ABSTRACT | FULL TEXT  

Noninvasive Ventilation and Dyspnea in Palliative Medicine
Nava et al.
Chest 2006;129:1391-1392.
FULL TEXT  

Palliative and End-of-Life Care for Patients With Cardiopulmonary Diseases: American College of Chest Physicians Position Statement
Selecky et al.
Chest 2005;128:3599-3610.
ABSTRACT | FULL TEXT  

Decision Making at a Time of Crisis Near the End of Life
Weissman
JAMA 2004;292:1738-1743.
ABSTRACT | FULL TEXT  

Palliative Care
Morrison and Meier
NEJM 2004;350:2582-2590.
FULL TEXT  

The quality of medical care at the end-of-life in the USA: existing barriers and examples of process and outcome measures
Yabroff et al.
Palliat Med 2004;18:202-216.
ABSTRACT  

The Comprehensive Care Team: A Controlled Trial of Outpatient Palliative Medicine Consultation
Rabow et al.
Arch Intern Med 2004;164:83-91.
ABSTRACT | FULL TEXT  

Advance Care Planning for Fatal Chronic Illness: Avoiding Commonplace Errors and Unwarranted Suffering
Lynn and Goldstein
ANN INTERN MED 2003;138:812-818.
ABSTRACT | FULL TEXT  

Older Persons' Ethical Problems Involving Their Health
Cameron
Nurs Ethics 2002;9:537-556.
ABSTRACT  

Management of Dyspnea in Patients With Far-Advanced Lung Disease
Markowitz and Rabow
JAMA 2002;287:2261-2261.
FULL TEXT