Role of opioids in the management of dyspnea at the end of life: A case report

Breathlessness or dyspnea is a subjective sensation of the inability to catch one's breath or an uncomfortable awareness of breathing. The prevalence of dyspnea is 21% - 70%, and it is a common symptom at the end of life. Dyspnea is a common and disabling symptom that affects many people with advanced cardiorespiratory diseases and cancer. The most effective therapies are aimed at treating the underlying disease. However, this is not always possible, and symptomatic treatment is often required in addition to maximal disease-directed therapy. In the palliative care setting, opioids are increasingly being used to treat dyspnea, although their mechanism of action is still not completely known. We present the case of a 53-year-old woman with worsening dyspnea who received opioids and died peacefully. She was admitted to the emergency room of our hospital with complaints of worsening dyspnea for the past 3 days, fatigue, general weakness, nausea, vomiting, and reduced appetite. The working diagnoses were acute respiratory distress syndrome, advanced breast cancer, pneumonia, wound bleeding, and chronic anemia. She received non-medical and medical therapies, including low dose opioid therapy. Her disease progressed, and eventually, she died peacefully at the hospital with her family after 30 days of treatment. The assessment and management of dyspnea are challenging for clinicians. Opioid use has been well documented in the palliative care setting; however, there is hesitancy when prescribing opioids until the terminal stage. Many medical societies recommend the use of oral and parenteral opioids for the treatment of dyspnea. Thus, opioids might be important in dyspnea management. Further research involving a large number of people is needed, and studies should assess the effects on quality of life.