Pharmacological intervention

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Some pharmacological agents can reduce breathlessness with no major adverse effects, and consequently may improve the quality of life. Such treatment is not used to substitute for specific therapy but should be considered because in many cases the clinical situation is irreversible.

Psychotropic drugs, specifically opioids, are the agents most frequently studied for the treatment of breathlessness. Their mechanisms of action are related to a reduction in ventilatory drive owing to a decrease in hypoxic and hypercapnic responses, and even more to an alteration of the central perception of breathlessness. Following morphine administration, there is a lower degree of breathlessness for a given level of ventilation.

Low-dose nebulized morphine is reported to improve breathlessness in patients with advanced lung disease. The small amounts of morphine administered in this way suggest that it has a local effect. This treatment has been suggested as palliative care for breathlessness in endstage situations.

Benzodiazepines have been considered to have a potential action in alleviating breathlessness. However, diazepam and alprazolam have proved ineffective in relieving this symptom. Buspirone is a non-benzodiazepine anxiolytic drug, and is better tolerated as it does not present sedative and anticholinergic actions. During buspirone treatment, chronic obstructive pulmonary disease patients show reduced anxiety and depression, and an improvement in exercise tolerance and sensations of dyspnea. A reduction in dyspnea has been observed using promethazine. It has been suggested that chlorpromazine could be useful for relieving breathlessness in dying patients.

Although obstruction is not reversible with bronchodilator treatment, it is possible that commonly used drugs may have an extrapulmonary action in reducing dyspnea. Theophylline improves diaphragmatic contraction, increases cardiac output, and reduces dyspnea, but its clinical significance has not been determined. Breathlessness is common in bronchial carcinoma related to airflow obstruction, and bronchodilator therapy may provide alleviation.

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