Pharmacology Consult: The Role of Nebulized Opioids in Managing Terminal Dyspnea: Implications for the Clinical Nurse Specialist
ELIZABETH DELANEY MS, RN, OCN, APRN/BC
JANE DOORLEY MS, RN, APRN/BC
MICHELLE HOBBS MS, RN, FNP
JAMES MURPHY MD

$3.95 		Clinical Nurse Specialist: The Journal for Advanced Nursing Practice
January 2003 
Volume 17  Number 1
Pages 19 - 21
 
  PDF Version Available!

ABSTRACT
Terminal dyspnea is one of the most difficult problems the clinical nurse specialist encounters in practice. This article explores the use of inhaled opioids for managing terminal dyspnea. The palliative care team who authored this article explore what is currently known and share their valuable experience in using inhaled opioids. Also provided is valuable advice to clinical nurse specialists who desire to use this therapy in practice. This article describes innovative methods to provide comfort and relieve suffering of patients, families, and their caregivers.

Patricia O'Malley, PhD, RN, CCRN, CNS

PHARMACOLOGY CONSULT

Increasingly, I find it more difficult to manage dyspnea in patients who are terminally ill. Despite the variety of available pharmacologic agents, patient outcomes are, at best, marginal. How can I best manage this symptom of end-stage chronic illness in patients who are terminally AQ ill?

PHARMACOLOGY RESPONSE

Dyspnea is a common and distressing symptom in patients who are terminally ill. Families view dyspnea as a symptom of distress because it conveys an image of suffering and is perceived to be a prognostic indicator of survival. It is estimated that 50%-70% of terminally ill patients experience dyspnea. 1

Dyspnea is defined as a subjective sensation of an uncomfortable awareness of breathing, breathlessness, or severe shortness of breath. 2 Also, the goal of care for the patient with terminal dyspnea is to alter the perception of breathlessness and to relieve the psychologic distress. Despite improvements in palliative care, managing terminal dyspnea is difficult. Palliative measures might include positional changes, facial cooling, oxygen, or the use of anxiolytics, diuretics, corticosteroids, anticholinergics, and bronchodilators. 3 These approaches, however, are not always effective. Results from preliminary reports suggest that nebulized opioids might be a viable option in some situations. 4

Clinical ...

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