Pharmacological management of breathlessness in advanced disease

Dyspnoea is one of the most distressing symptoms experienced by patients with life-limiting illnesses; when not relieved by disease management strategies it is termed 'refractory dyspnoea' and global palliative approaches are required. The focus of care shifts from prolonging survival to reducing symptoms, increasing function, and improving quality of life. Numerous pharmacological and non-pharmacological interventions can achieve these goals, though the level of evidence supporting their use varies. This narrative review provides a summary of pharmacological options for the management of refractory breathlessness, with a focus on those options with adequate supporting data; oxygen therapy is also considered as a potentially viable palliative measure. Currently available evidence is provided, highlighting areas for further investigation of selected approaches. The agents with adequate current evidence warranting inclusion as current 'best practices' are: oxygen, opioids, psychotropic drugs, inhaled frusemide, and Heliox 28.