Refractory breathlessness: oxygen or room air?

Abstract

Breathlessness is a frightening and devastating symptom which affects patients with many diseases in advanced stages. The prevalence reaches 90% in cancer, 95% in chronic obstructive pulmonary disease (COPD), 88% in cardiac failure, 1 Solano JP Gomes B Higginson IJ A comparison of symptom prevalence in far advanced cancer, AIDS, heart disease, chronic obstructive pulmonary disease and renal disease. J Pain Symptom Manage. 2006; 31: 58-69 Summary Full Text Full Text PDF PubMed Scopus (804) Google Scholar and 80% in advanced-stage renal disease. 2 Murtagh FE Addington-Hall J Edmonds P et al. Symptoms in the month before death for stage 5 chronic kidney disease patients managed without dialysis. J Pain Symptom Manage. 2010; (published online June 24.)https://doi.org/10.1016/j.jpainsymman.2010.01.021 Summary Full Text Full Text PDF PubMed Scopus (83) Google Scholar Patients with various neurological conditions also become breathless. 3 Higginson IJ Hart S Silber E Burman R Edmonds P Symptom prevalence and severity in people severely affected by multiple sclerosis. J Palliat Care. 2006; 22: 158-165 PubMed Google Scholar , 4 Saleem T Leigh PN Higginson IJ Symptom prevalence among people affected by advanced and progressive neurological conditions—a systematic review. J Palliat Care. 2007; 23: 291-299 PubMed Google Scholar Oxygen therapy is often used to manage breathlessness. However, although there is accepted evidence for using oxygen in patients with COPD and hypoxaemia, 5 Wilt TJ Niewoehner D MacDonald R Kane RL Management of stable chronic obstructive pulmonary disease: a systematic review for a clinical practice guideline. Ann Intern Med. 2007; 147: 639-653 Crossref PubMed Scopus (95) Google Scholar palliative oxygen is often used in patients with advanced life-limiting illness, irrespective of the partial pressure of oxygen in arterial blood (PaO2). Three systematic reviews raised concerns about a lack of robust evidence with trials that were underpowered, inadequately controlled, or had unclear outcomes. 6 Gallagher R Roberts D A systematic review of oxygen and airflow effect on relief of dyspnea at rest in patients with advanced disease of any cause. J Pain Palliat Care Pharmacother. 2004; 18: 3-15 Crossref PubMed Google Scholar , 7 Uronis HE Currow DC McCrory DC Samsa GP Abernethy AP Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis. Br J Cancer. 2008; 98: 294 Crossref PubMed Scopus (121) Google Scholar , 8 Cranston JM Crockett A Currow D Oxygen therapy for dyspnoea in adults. Cochrane Database Syst Rev. 2008; 3 (CD004769) PubMed Google Scholar Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind, randomised controlled trialSince oxygen delivered by a nasal cannula provides no additional symptomatic benefit for relief of refractory dyspnoea in patients with life-limiting illness compared with room air, less burdensome strategies should be considered after brief assessment of the effect of oxygen therapy on the individual patient. Full-Text PDF