Applicability and generalizability of palliative interventions for dyspnoea: one size fits all, some or none?

PURPOSE OF REVIEW: Determining which palliative interventions are appropriate within and between groups remains difficult because of the lack of prospective studies and heterogeneity in dyspnoea context, assessment and reporting. This review presents an evolution of dyspnoea theories, summarizes literature published during 2010 concerning intervention effectiveness between conditions and highlights the lag between emerging research evidence and dyspnoea assessments in clinical trials. RECENT FINDINGS: With few exceptions, first-line pharmacological agents prescribed to modify the disease with palliation of dyspnoea as consequence were unlikely to be generalizable between conditions and contexts. Two agents (supplemental oxygen in people without resting hypoxemia and benzodiazepines in advanced disease) did not significantly reduce dyspnoea. Exercise training palliated dyspnoea across conditions and contexts. Short-term reductions in dyspnoea were reported for a variety of adjunctive strategies (breathing training, electrophysical agents and psychological approaches). SUMMARY: Multiple interventions exist for palliation of dyspnoea in different contexts. The majority of studies assessed emotional and behavioural consequences of dyspnoea rather than dyspnoea sensation (intensity, sensory quality, unpleasantness). As a more detailed understanding of the mechanisms leading to perceptions of dyspnoea evolve, a 'back to basics' strategy for clinical assessment might provide a means of determining which interventions can be generalized or are best suited to various forms of dyspnoea.