Treating Episodic Breathlessness

Abstract Episodic breathlessness, a time-limited worsening of breathlessness intensity, occurs frequently in patients with advanced disease despite optimal treatment of underlying disease. It requires symptomatic treatment. Breathlessness episodes are often associated with anxiety. Due to the short average duration of episodes, nonpharmacological strategies are the first-line treatment and facilitate self-management. Breathing techniques and body positioning help the patient to ease breathing. Cooling the face (e.g., by a handheld fan), activity pacing, and cognitive-behavioral strategies such as relaxation techniques and distraction can help the patient to manage episodes. Educating the patient and the family is crucial; teaching topics include information about breathlessness, underlying disease, average length of episodes, triggers, and strategies to manage episodes. For prolonged breathlessness episodes, opioids can provide symptomatic relief and benzodiazepines may reduce breathlessness-related anxiety.