The Advanced Practice Nurse's Role in Palliative Care and the Management of Dyspnea

Rose Anne Indelicato, MSN, APRN-BC, PCM-BC, OCN


Topics in Advanced Practice Nursing eJournal. 2006;6(4) 

In This Article

Nonpharmacologic Interventions in the Management of Dyspnea

In addition to pharmacologic interventions and oxygen, there are a number of nonpharmacologic strategies that can be beneficial in the management of dyspnea. By changing a patient's physical environment and educating patients and their caregivers about some of these nondrug therapies, the APN can offer the patient a sense of control and an arsenal of strategies that, when added to medication management, may have a positive impact on the experience of breathlessness.

Patients may benefit from sitting upright in bed or a chair. They may also obtain relief from sitting on the edge of a bed, resting their upper body on a bedside table.[14] Additionally, patients should be educated to prioritize and pace activities. Premedication with an opioid or a bronchodilator before engaging in any strenuous activities (eg, bathing, eating, walking) also may improve outcomes.

Pursed lip breathing promotes movement of air out of the lungs and increases airway pressure, thereby keeping the airway open.[72] Slow breaths decrease respirations, allowing for less tiring and more efficient breathing.[3,48,73] Teach this technique to a patient or caregiver, following these steps:

  • Begin with relaxing neck and shoulders,

  • Close your mouth and inhale slowly through your nose

  • Purse your lips as if you were going to whistle and exhale slowly over a count of 3.[72]

Patients who experience dyspnea appear to benefit from a cool, smoke-free and dust-free room with low humidity. Breeze from an open window or from a fan directed toward a patient's face may lessen the sensation of breathlessness.

This phenomenon may be explained by the physiologic stimulation of the V2 branch of the fifth cranial nerve, creating a centrally inhibitory effect on the sensation of dyspnea.[74]

In addition, the use of durable medical equipment such as a hospital bed, portable oxygen, walker, wheelchair, bedside table, or bedside commode may limit exertion, thus decreasing breathlessness.[27,48,73,75]

Anxiety can be a significant cause and exacerbating factor in the occurrence of dyspnea. Some techniques that may assist a patient in coping with the emotional component of dyspnea include progressive muscle relaxation, guided imagery, and distraction.[73,76]

Corner and colleagues[77] implemented a nurse-run clinic that included counseling, breathing retraining, relaxation, and education related to coping and adaptation strategies for 20 patients with advanced lung cancer who were experiencing dyspnea. Distress from breathlessness was improved by a median of 53%, while the control group's distress worsened by 10%.

Music therapy also can help patients reduce their respiratory rates and may play an important role in the management of breathlessness, although further research is needed.[60]

Finally, acupressure or acupuncture also may provide benefit in the management of dyspnea. In one study, cancer patients who had acupuncture needles applied to sternal points experienced improvements in breathing, the ability to relax, a reduction in anxiety, and a 90-minute to 6-hour decrease in respiratory rate.[78] In a more recent, single-blind, randomized crossover study, acupuncture was compared with placebo in patients with disabling, nonmalignant breathlessness. Although the acupuncture did not show specific efficacy, those patients entered into the study did experience clinically significant benefit from both treatments.[79]


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