Relieving chronic breathlessness is a human right
Abstract
Chronic breathlessness, defined as breathlessness that persists despite optimising the treatment of underlying causes, is recognised by recent international consensus as a distinct clinical syndrome. Across our communities, population-based studies of chronic breathlessness expose an enormous burden from this. Among the palliative care population, one in four people die with severe breathlessness despite treatment from a palliative care service. Recently, the relief of breathlessness was claimed to be a human right, particularly when there are treatments available to alleviate the unnecessary suffering caused by chronic breathlessness. The timely recognition of, and response to chronic breathlessness is a crucial clinical skill.
Keywords: palliative carechronic breathlessnesshealth and well-beinghuman rightchronic disease
References
- Johnson MJ, Yorke J, Hansen-Flaschen J, et al. Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness. Eur Respir J. 2017; 49(5).
- Currow DC, Dal Grande E, Ferreira D, et al. Chronic breathlessness associated with poorer physical and mental health-related quality of life (SF-12) across all adult age groups. Thorax. 2017; 72(12): 1151–1153.
- Hutchinson A, Pickering A, Williams P, et al. Breathlessness and presentation to the emergency department: a survey and clinical record review. BMC Pulm Med. 2017; 17(1): 53.
- Troosters T, Sciurba F, Battaglia S, et al. Physical inactivity in patients with COPD, a controlled multi-center pilot-study. Respir Med. 2010; 104(7): 1005–1011.
- Frostad A, Soyseth V, Haldorsen T, et al. Respiratory symptoms and 30 year mortality from obstructive lung disease and pneumonia. Thorax. 2006; 61(11): 951–956.
- Voll-Aanerud M, Eagan TML, Wentzel-Larsen T, et al. Changes in respiratory symptoms and health-related quality of life. Chest. 2007; 131(6): 1890–1897.
- Currow DC, Plummer JL, Crockett A, et al. A community population survey of prevalence and severity of dyspnea in adults. J Pain Symptom Manage. 2009; 38(4): 533–545.
- Currow DC, Smith J, Davidson PM, et al. Do the trajectories of dyspnea differ in prevalence and intensity by diagnosis at the end of life? A consecutive cohort study. J Pain Symptom Manage. 2010; 39(4): 680–690.
- Johnson MJ, Bowden JA, Abernethy AP, et al. To what causes do people attribute their chronic breathlessness? A population survey. J Palliat Med. 2012; 15(7): 744–750.
- Nishimura K, Izumi T, Tsukino M, et al. Dyspnea is a better predictor of 5-year survival than airway obstruction in patients with COPD. Chest. 2002; 121(5): 1434–1440.
- Hammond EC. Some preliminary findings on physical complaints from a prospective study of 1,064,004 men and women. Am J Public Health Nations Health. 1964; 54: 11–23.
- The right to health. Fact Sheet 31. Office of the United nations High Commissioner for Human Rights / World Health Organisation. Geneva June 2008. http://www.ohchr.org/Documents/Publications/Factsheet31.pdf (Accessed 06 Feb, 2018).
- Constitution of the World Health Organisation. Forty-fifth edition, Supplement, October 2006. http://www.who.int/governance/eb/who_constitution_en.pdf (Accessed Feb 06, 2018).
- International Covenant on Economic, Social and Cultural Rights. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CESCR.aspx (Accessed 06 Feb, 2018).
- Declaration of Alma-Ata. http://www.who.int/publications/almaata_declaration_en.pdf (Accessed 06 Feb, 2018.).
- Sixty–Seventh World Health Assembly. Agenda item 15.5. Strengthening of palliative care as a component of comprehensive care throughout the life course. Geneva. 2014 May 24. http://apps.who.int/medicinedocs/documents/s21454en/s21454en.pdf (Accessed 4 February 2018).
- Marciniuk DD, Goodridge D, Hernandez P, et al. Canadian Thoracic Society COPD Committee Dyspnea Expert Working Group. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline. Can Respir J. 2011; 18(2): 69–78.
- Ekström M, Bajwah S, Bland JM, et al. One evidence base; three stories: do opioids relieve chronic breathlessness? Thorax. 2018; 73(1): 88–90.
- Ekström MP, Bornefalk-Hermansson A, Abernethy AP, et al. Safety of benzodiazepines and opioids in very severe respiratory disease: national prospective study. BMJ. 2014; 348: g445.