Download PDF
Zeitschrift für Palliativmedizin 2007; 8(4): 143-154
DOI: 10.1055/s-2007-986254
CME-Fortbildung

© Georg Thieme Verlag KG Stuttgart · New York

Diagnostik und Therapie der Atemnot in der Palliativmedizin

Diagnostics and Therapy of Dyspnoea in Palliative MedicineK.  E.  Clemens, E.  Klaschik
Further Information

Publication History

Publication Date:
11 December 2007 (online)

Also available at
    Permissions and Reprints

Abstract

Respiratory symptoms, such as tussis, haemoptysis, pleural effusion and dyspnoea, are common in palliative care patients and tend to increase as the underlying disease advances. Compared to the other symptoms, dyspnoea is of different nature, insofar as it is a subjective symptom where only the patient himself is in a position to judge its severity. It is not self-evident that measurable pathophysiological changes are to be found. Profound knowledge of physiology and pathophysiology is indispensable for targeted diagnostics and rational therapy. Key strategies of treatment include measures that will reduce increased breathing effort and respiratory rate, improve CO2 elimination and have a positive impact on the distressing and emotional response to the experience of air hunger.

Literatur

  • 1 Gugger M, Bachofen H. Dyspnoe, Grundlagen und Pathophysiologie.  Schweiz Med Forum. 2001;  Nr. 6
    PubMedGoogle Scholar
  • 2 Pfreundschuh M, Schölmerich J. Pathophysiologie/Pathobiochemie. München; Urban & Fischer 2000: 187-206
    Google Scholar
  • 3 Thews G. Lungenatmung. In: Schmidt RF, Thews G (Hrsg) Physiologie des Menschen. 24. Aufl. Berlin; Springer 1990: 574-609
    Google Scholar
  • 4 Thews G. Lungenatmung. In: Schmidt RF, Thews G (Hrsg) Physiologie des Menschen. 27. Aufl. Berlin; Springer 1997: 565-603
    Google Scholar
  • 5 Moosavi S H, Golestanian E, Binks A P. et al . Hypoxic and hypercapnic drives to breathe generate equivalent levels of air hunger in humans.  J Appl Physiol. 2003;  94 141-154
    PubMedGoogle Scholar
  • 6 Thews G. Lungenatmung. In: Schmidt RF, Thews G (Hrsg) Physiologie des Menschen. 17. Aufl. Berlin; Springer 1976: 452-486
    Google Scholar
  • 7 Zander R. Sauerstoff von A-Z: Von der Alveole bis zur Zelle. Refresher Course. Aktuelles Wissen für Anästhesisten. Herausgegeben von der Deutschen Akademie für Anästhesiologische Fortbildung, Nürnberg. Juni 2002 Nr. 28
    Google Scholar
  • 8 Clemens K E, Klaschik E. Respiratorische Symptome. In: Aulbert E, Nauck F, Radbruch L (Hrsg) Lehrbuch der Palliativmedizin. 2. Aufl. Stuttgart; Schattauer 2007: 375-393
    Google Scholar
  • 9 Manning H L, Schratzenstein R M. Pathophysiology of Dyspnea. Review.  N Engl J Med. 1995;  333 1547-1553
    CrossrefPubMedGoogle Scholar
  • 10 Bruera E, Sweeney K, Willey J. et al . A randomized controlled trial of supplemental oxygen versus air in cancer patients with dyspnea.  Palliat Med. 2003;  17 659-663
    PubMedGoogle Scholar
  • 11 Ventafridda V. Palliative Care: A new reality in medicine.  Rec Res Cancer Res. 1991;  121 393-398
    PubMedGoogle Scholar
  • 12 Bausewein C, Farquhar M, Booth S. et al . Measurement of breathlessness in advanced disease: a systematic review.  Respir Med. 2007;  101 399-410
    CrossrefPubMedGoogle Scholar
  • 13 Klaschik E. Schmerztherapie und Symptomkontrolle in der Palliativmedizin. In: Husebö S, Klaschik E (Hrsg) Palliativmedizin. 4. Aufl. Berlin; Springer 2006: 276-279
    Google Scholar
  • 14 Bourke D L, Warley A. The steady state and breathing methods compared during morphine administration in humans.  J Physiol. 1989;  419 509-517
    PubMedGoogle Scholar
  • 15 Clemens K E, Klaschik E. Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients.  J Pain Symptom Manage. 2007;  33 (4) 473-481
    CrossrefPubMedGoogle Scholar
  • 16 Bouillon T, Bruhn J, Roepcke H. et al . Opioid-induced respiratory depression is associated with increased tidal volume variability.  Eur J Anaesthesiol. 2003;  20 (2) 127-133
    Google Scholar
  • 17 Argyropoulou P, Patakas D, Koukou A. et al . Buspirone effect on breathlessness and exercise performance in patients with chronic obstructive pulmonary disease.  Respiration. 1993;  60 (4) 216-220
    PubMedGoogle Scholar
  • 18 Ahmedzai S. Palliation of respiratory symptoms. In: Doyle D, Hanks GWC, MacDonald N (eds) Oxford Textbook of Palliative Medicine. 2nd. ed. Oxford; Oxford Univ Press 1998: 583-616
    Google Scholar
  • 19 Doyle D. Domicially terminal care. Edinburgh; Churchill Livingstone 1987: 33-34
    Google Scholar
  • 20 Green K, Webster H, Watanabe S. et al . Management of nosocomial respiratory tract infections in terminally ill cancer patients.  J Palliat Care. 1994;  10 (4) 31-34
    PubMedGoogle Scholar
  • 21 Oneschuk D, Faisinger R, Demoissac D. Antibiotic use in the last week of life in three different palliative care settings.  J Palliat Care. 2002;  18 (1) 25-28
    PubMedGoogle Scholar
  • 22 Pereira J, Watanabe S, Wolch G. A retrospective review of the frequency of infections and patterns of antibiotic utilization on a palliative care unit.  J Pain Symptom Manage. 1998;  16 (6) 374-381
    CrossrefPubMedGoogle Scholar
  • 23 Vietta L, Kenner D. et al . A bacterial infection in terminally ill hospice patients.  J Pain Symptom Manage. 2000;  20 (5) 326-334
    CrossrefPubMedGoogle Scholar
  • 24 Sorbye L W. A longitudinal study on dying in a Norwegian hospital.  Int J Palliat Nurs. 2000;  6 (2) 71-79
    PubMedGoogle Scholar
  • 25 Evers M M, Purohit D, Perl D. et al . Palliative and aggressive end-of-life care for patients with dementia.  Psychiatr Serv. 2002;  53 (5) 609-613
    CrossrefPubMedGoogle Scholar
  • 26 Philip J, Gold M, Milner A. et al . A randomized, double-blind, crossover trial of the effect of oxygen on dyspnoea in patients with advanced cancer.  J Pain Symptom Manage. 2006;  32 (6) 541-550
    CrossrefPubMedGoogle Scholar
  • 27 Higginson I J, McCarthy M. Measuring symptoms in terminal cancer: are pain and dyspnoea controlled?.  J Royal Soc Med. 1989;  82 264-267
    PubMedGoogle Scholar
  • 28 Wilcock A. The management of respiratory Symptoms. In: Faull C, Carter Y, Woof R (eds) Handbook of Palliative Care. Oxford; Blackwell 1998 Chapter 11: 157-176
    Google Scholar
  • 29 Driver L C, Bruera E. Dyspnea. In: Driver LC, Bruera E The M.D. Anderson Palliative Care Handbook. 2nd. ed. Houston, TX; University of Texas, M.D. Anderson Cancer Centre 2002: 71-76
    Google Scholar

Dr. med. Katri Elina Clemens

Lehr- und Forschungsstelle Universität Bonn, Zentrum für Palliativmedizin, Malteser Krankenhaus Bonn/Rhein-Sieg

Von-Hompesch-Straße 1

53123 Bonn

Email: katri-elina.clemens@malteser.de

      >