Dyspnea management in palliative care: current approaches and treatment strategies

Year 2025, Volume: 6 Issue: 2, 167 - 173, 23.03.2025

Emrah Arı

https://doi.org/10.47582/jompac.1641795

Abstract

Dyspnea is a common and challenging symptom to manage in palliative care patients. This review discusses the pathophysiology, assessment methods, and current treatment approaches for dyspnea based on the existing literature. Both pharmacological (opioids, benzodiazepines, glucocorticoids) and non-pharmacological (oxygen therapy, respiratory therapy, environmental modifications) treatment strategies are examined in detail, with a discussion on their efficacy and potential side effects. This study is a narrative review compiling the current literature on the topic.

Keywords

Dyspnea, palliative care, symptom management, multidisciplinary approach

Palyatif bakımda dispne yönetimi: güncel yaklaşımlar ve tedavi stratejileri

Abstract

Dispne, ileri evre hastalıklara sahip hastalarda yaygın ve rahatsız edici bir semptom olup yaşam kalitesini önemli ölçüde olumsuz etkilemektedir. Karmaşık fizyolojik ve psikolojik mekanizmalarla ilişkili olan bu semptomun etkili yönetimi, palyatif bakımda multidisipliner bir yaklaşım gerektirmektedir. Tedavi stratejileri, bireysel hasta ihtiyaçlarına göre uyarlanmış farmakolojik ve non-farmakolojik girişimleri içermektedir. Farmakolojik tedavide opioidler, özellikle morfin, dispne yönetiminde temel tedavi seçeneği olup solunum çabasını azaltarak hastaların rahatlamasına katkı sağlamaktadır. Fentanil ve oksikodon gibi alternatif opioidler belirli vakalarda tercih edilebilmektedir. Ancak sedasyon, solunum depresyonu ve konstipasyon gibi yan etkiler nedeniyle doz titrasyonunun dikkatli yapılması gerekmektedir. Benzodiazepinler, dispne ile ilişkili anksiyete durumunda faydalı olabilir, ancak anksiyete komponenti bulunmayan hastalarda rutin kullanımları önerilmemektedir. Malign hava yolu obstrüksiyonu, lenfanjitik karsinomatozis veya kalp yetmezliği kaynaklı dispnede glukokortikoidler ve diüretikler tedavi seçenekleri arasında yer almaktadır. Non-farmakolojik yaklaşımlar arasında oksijen tedavisi, pulmoner rehabilitasyon ve solunum egzersizleri semptomatik rahatlama açısından önemli rol oynamaktadır. Oksijen tedavisi, hipoksemik hastalarda etkili olup, hipoksemi bulunmayan hastalarda sınırlı yarar sağlamaktadır. Diyafragmatik solunum ve büzük dudak solunumu gibi solunum teknikleri, solunum verimliliğini artırabilir. Non-invaziv mekanik ventilasyon belirli hastalarda düşünülebilse de palyatif bakımda etkinliği konusunda tartışmalar devam etmektedir. Tedaviye dirençli dispne vakalarında, palyatif sedasyon son çare olarak değerlendirilebilmekte olup etik hususlar ve hasta ile bakım verenler arasındaki iletişimin titizlikle yürütülmesi gerekmektedir. Dispnenin etkili yönetimi, farmakolojik ve non-farmakolojik yaklaşımları entegre eden, hasta merkezli ve bireyselleştirilmiş bir strateji gerektirir. Bu doğrultuda, hastaların semptom kontrolünü optimize etmek ve yaşam kalitesini artırmak amacıyla multidisipliner bir yaklaşımın benimsenmesi büyük önem taşımaktadır.

Keywords

Dispne, Palyatif Bakım, Semptom Yönetimi, Multidisipliner Yaklaşım

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