Management of dyspnea in patients with advanced lung or heart disease. Practical guidance from the American College of Chest Physicians Consensus Statement

INTRODUCTION: Patients with advanced lung or heart disease are not generally being treated consistently and effectively for relief of dyspnea. OBJECTIVES: The aim of the paper was to review available literature and to provide consensus statements using the Delphi method relevant to the topic condition. PATIENTS AND METHODS: A panel of experts of the American College of Chest Physicians (ACCP) defined the topic condition as “dyspnea that persists at rest or with minimal activity and is distressful despite optimal therapy of advanced lung or heart disease.” After a literature review, the panel developed 23 statements that were assessed for agreement/disagreement on a 5‑point Likert scale using 2 rounds of the Delphi method. RESULTS: For the first round of the Delphi method, the survey was sent to the 15 expert panel members. Some statements were modified if deemed appropriate. For the second round of the Delphi method, 23 statements were sent to 56 clinicians from 5 relevant specialty NetWork steering committees of the ACCP. Agreement of at least 70% was achieved for 20 of the 23 statements. CONCLUSIONS: There was consensus that: patients with advanced lung or heart disease should be asked about the intensity and distress of their breathlessness; pursed‑lips breathing, relaxation, oxygen for those with hypoxemia, noninvasive positive pressure ventilation, and oral/parental opioids can provide relief of dyspnea; therapies should be started with the understanding that the patient and clinician will reassess whether the specific treatments are relieving dyspnea without causing adverse effects; and it is important to communicate about palliative and end‑of‑life care.