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The bottom lineBreathlessness—the sensation of discomfort with breathing—is a major cause of impaired activity and suffering worldwide and is common among elderly people in the community and in people with advanced disease.1 w1 Proper evaluation and treatment of breathlessness is vital to improve patients’ quality of life.Importantly, the sensation of breathlessness that persists despite disease specific treatment can be relieved for many people. This review focuses on the management of refractory breathlessness, defined as breathlessness at rest or on limited exertion that persists despite optimal treatment of the underlying conditions, in advanced chronic disease, or towards the end of life.2 w4 Sources and selection criteriaWe searched Medline, the Cochrane Database of Systematic Reviews, reference lists of major reviews, guidelines and consensus documents, and personal records using the terms “dyspnea” and “breathlessness”. We focused on systematic reviews, meta-analyses, randomized controlled trials, and high quality observational studies in patients with advanced or terminal disease.Breathlessness is defined by the American Thoracic Society as the “subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity.”w1 According to the present neurophysiological model, breathlessness is the awareness of a mismatch between the ventilator drive (the need to …

The management of chronic breathlessness in patients with advanced and terminal illness