Dyspnea in the dying patient

Dyspnea is one of the most frequent symptoms described by patients with terminal illness. It is distressing, debilitating, and has a significant impact on quality of life. While there are multiple etiologies and multiple pathophysiologic mechanisms that lead a patient to suffer from dyspnea, there exists a discrete evidence-based skillset which may be employed to systematically treat advanced cancer patients who present to the emergency department with shortness of breath. Undifferentiated dyspnea, often related to progression of disease, may be reliably and rapidly treated with opioids. In certain populations, disease-specific interventions may be appropriate. Certain interventions such as thoracentesis for malignant pleural effusion, blood transfusion for symptomatic anemia, or corticosteroid administration for tumor burden all come with risks which must be weighed against any potential benefit to patient and family. By understanding the mechanism and evidence for each of these treatment modalities, emergency providers will be better prepared to deliver individualized treatment consistent with patient’s goals of care.