Terminally ill patients in hospice or palliative care settings might experiencedyspnea(difficulty breathing) as they near the end of their lives. Dyspnea may be related to an underlying disease, such as lung cancer orchronic obstructive pulmonary disease(COPD), or a secondary cause such as pneumonia.
Oxygen therapy is usually the first line of treatment, but other non-medical interventions may help, too.
This article discusses dyspnea at the end of life, what causes it, and how it can be managed.
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What Is Dyspnea?
Dyspnea is a shortness of breath or difficult orlabored breathingthat can sometimes occur suddenly.People experiencing dyspnea often describe it asshortness of breath, tightness in their chest, fighting for air, or feeling smothered. Or they might simply say, “I can’t breathe.”
In some cases, a patient’srespiration rate(how rapidly they breathe in and out) will increase and their chest might constrict as the patient tries to get enough air while breathing.
Normal breathing and the exchange of oxygen for carbon dioxide is a combination of the rate of breathing (breaths per minute) and the volume of air per breath (tidal volume). Patients experiencing dyspnea might try to increase the rate of their breathing or the tidal volume.
If an individual’s oxygen levels are severely compromised, discoloration might occur in their nail beds and/or lips, a serious condition calledcyanosis.
What Is Cyanosis?
What Are the Causes of Dyspnea?
There are many causes of dyspnea in end-of-life situations. The cause is sometimes directly related to the patient’s underlying disease—especially if the diagnosis involves the respiratory system, such aslung canceror chronic obstructive pulmonary disease (COPD).
Dyspnea can also occur due to secondary causes, such as pneumonia or chemotherapy, or due to the lungs overcompensating for the failure of another organ, such as the kidney or heart. Typically, several factors can contribute to a terminally ill patient experiencing dyspnea.
Because breathing is something we generally take for granted, individuals experiencing dyspnea often experience heightened anxiety. Anxiety can cause cognitive, emotional, behavioral, and physical manifestations that exacerbate dyspnea, so it’s important to manage a patient’s anxiety, too.
Up to 70% of patients will experience dyspnea at the end of life.Some patients find their shortness of breath/breathing difficulties more distressing than physical pain.
What Other Breathing Changes Happen Before Death?
Dyspnea isn’t the only breathing change you might notice in a person nearing the end of life.
Changes in breathing may come on suddenly and last for only a short period before the person’s death, or they may happen over days or hours. Some of the breathing patterns that can occur at the end of life include:
What is the timeline for actively dying?There is no settimeline for actively dying. Some people go through the process quickly, while others may take days or even weeks. Generally speaking, however, the dying process tends to follow a similar progression for everyone, in the following general order:Reductions in appetite or thirstIncreased need for sleepLower body temperature and blood pressureSkin color changesLess talking/communicationConfusion, restlessness, hallucinations, or delusionsSleeping more often than notA brief surge of energyBreathing changesUnresponsivenessDeath
What is the timeline for actively dying?
There is no settimeline for actively dying. Some people go through the process quickly, while others may take days or even weeks. Generally speaking, however, the dying process tends to follow a similar progression for everyone, in the following general order:Reductions in appetite or thirstIncreased need for sleepLower body temperature and blood pressureSkin color changesLess talking/communicationConfusion, restlessness, hallucinations, or delusionsSleeping more often than notA brief surge of energyBreathing changesUnresponsivenessDeath
There is no settimeline for actively dying. Some people go through the process quickly, while others may take days or even weeks. Generally speaking, however, the dying process tends to follow a similar progression for everyone, in the following general order:
Medical Treatments for Dyspnea
Because the goal ofpalliative careand hospice for terminally ill patients is to provide comfort, you most likely shouldnotcall 911. In these situations, if your loved one or patient experiences dyspnea, you should contact their treating physician immediately.
The doctor or a nurse will guide you in the best treatment to provide comfort. If your patient is under hospice care, you should call the hospice agency, and a hospice nurse will give you instructions over the phone before possibly sending a nurse out to evaluate the patient’s symptoms.
Otherwise, medical treatments/interventions for dyspnea in hospice and palliative-care settings generally focus on relieving the patient’s feeling of breathlessness:
Non-Medical Treatments for Dyspnea
Non-medical interventions are important in treating dyspnea and can be implemented during medical treatment or while you wait for medical help to arrive.Some things you can do include the following:
Summary
Other abnormal breathing patterns such as “death rattle,” Cheyne-Stokes breathing, or agonal breathing may also happen in the weeks, hours, or minutes before death.
Dyspnea may be managed with oxygen or with medications that help control the anxiety associated with it.
10 Sources
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