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- RE: Role of benzodiazepines in dyspnea
We thank Dr Slawnych for his excellent “Practice” article on dyspnea and agree, “No one should die suffering from breathlessness”. We wish to provide observations on the role of benzodiazepines, antipsychotics and other psychotropics for dyspnea, from our perspective as palliative care providers. Like Dr. Slawnych, we acknowledge the dearth of evidence supporting clinical practice.
Dr Slawnych mentions the use of benzodiazepines as second line agents if symptoms persist despite opioids. We appreciate that there is mention of referral to palliative medicine physicians in these circumstances. However, given limited access to this specialty, we are concerned that this recommendation may lead to increased use of benzodiazepines. A 2016 Cochrane review notes that benzodiazepines have limited efficacy for dyspnea, although they are potentially helpful for anxiety caused by the sensation of dyspnea1. Similarly, the Cancer Care Ontario guidelines suggest use of benzodiazepines for anxiety in patients who have higher PPS and do not recommend them for dyspnea itself2.
The article comments on the role of antipsychotics such as methotrimeprazine for management of agitation related to dyspnea but there is some evidence of benefits for specific antipsychotics for dyspnea itself. As with benzodiazepines there is limited evidence but our experience is they have the potential to alleviate dyspnea, not just agitation, and may be especially relevant later in the course of illn...
Show MoreCompeting Interests: None declared.References
- Michael P. Slawnych. Management of dyspnea at the end of life. CMAJ 2020;192:E550-E550.
- 1. Simon ST, Higginson IJ, Booth S, Harding R, Weingärtner V, Bausewein C. Benzodiazepines for the relief of breathlessness in advanced malignant and non-malignant diseases in adults. Cochrane Database Syst Rev. 2016;10(10):CD007354. Published 2016 Oct 20
- 2. Cancer Care Ontario Dyspnea Algorithm https://www.cancercareontario.ca/en/symptom-management/3126
- 3. Watts GJ, Clark K, Agar M et al Study protocol: a phase III randomised, double-blind, parallel arm, stratified, block randomised, placebo-controlled trial investigating the clinic effect and cost-effectiveness of sertraline for the palliative relief of