Dyspnoea in palliative care
Reversible causes of breathlessness in advanced cancer and organ failure, non-drug measures that work, when oxygen helps, where opioids now stand after BEAMS and MABEL, and managing a breathlessness crisis in the last days of life.
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Written with AI assistance and fact-checked against the sources below. For exam study, not clinical decisions. How notes are made
At a glance
- Breathlessness affects up to 70% of people with advanced cancer in the last weeks of life and most people with end-stage COPD, ILD, heart failure and motor neurone disease. It frightens patients and families more than almost any other symptom.
- First look for a reversible cause that fits the patient's goals: effusion, anaemia, PE, infection, airway obstruction, SVCO, heart failure, ascites.
- For persistent breathlessness, non-drug measures come first: fan, positioning, breathing and pacing techniques, help with anxiety.
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Sources
- Therapeutic Guidelines: Palliative Care (eTG complete), version 5AU/NZTherapeutic Guidelines Limited, 2024 (version 5, December 2024)
- Hui D et al. Management of dyspnea in advanced cancer: ASCO guideline. J Clin Oncol 2021;39:1389-1411American Society of Clinical Oncology, 2021 (current at November 2026)
- Hui D et al. Management of breathlessness in patients with cancer: ESMO Clinical Practice Guidelines. ESMO Open 2020;5:e001038European Society for Medical Oncology, 2020 (current at November 2026)
- Parshall MB et al. An official American Thoracic Society statement: update on the mechanisms, assessment, and management of dyspnea. Am J Respir Crit Care Med 2012;185:435-52American Thoracic Society, 2012
- European Respiratory Society clinical practice guideline on symptom management for adults with serious respiratory illnessEuropean Respiratory Society (Holland et al, Eur Respir J), 2024
- Johnson MJ et al. Morphine for chronic breathlessness (MABEL) in the UK: a multi-site, parallel-group, randomised, placebo-controlled trial. Lancet Respir Med 2025;13:967-977Lancet Respiratory Medicine, 2025
- Ekström M et al. Effect of regular, low-dose, extended-release morphine on chronic breathlessness in COPD (BEAMS). JAMA 2022;328:2022-2032JAMA, 2022
- Higginson IJ et al. Mirtazapine to alleviate severe breathlessness in patients with COPD or interstitial lung diseases (BETTER-B). Lancet Respir Med 2024;12:763-774Lancet Respiratory Medicine, 2024
- Abernethy AP et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea. Lancet 2010;376:784-93The Lancet, 2010
- Thomas R et al. Effect of an indwelling pleural catheter vs talc pleurodesis on hospitalization days in patients with malignant pleural effusion (AMPLE). JAMA 2017;318:1903-1912AU/NZJAMA, 2017
- Last updated
- 14 November 2026
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