The authors review the pathophysiology, assessment and drug treatment of dyspnoea. Specific drug treatments discussed are theophylline, antiprostaglandins, benzodiazepines, phenothiazines, opioids and local anaesthetics.
Fishbein D., Kearon C., Killian J.An approach to dyspnea in cancer patients. Journal of Pain and Symptom Management1989; 4: 76-81.
3.
Mahler DADyspnea: diagnosis and management. Clin Chest Med1987; 8: 215-30.
4.
Ventafridda V. , Caraceni A., Saita L., Sbanotto A., Spoldi E., De Conno F.Symptom control in palliative care. In: Domellof L ed, Drug delivery in cancer- treatment III. Berlin: Springer Verlag, 1990.
5.
Reuben DB, Mor V.Dyspnea in terminally ill cancer patients. Chest1986; 89: 234-36.
6.
Jones PWMeasuring the quality of life of patients with respiratory disease. In: Walker SR, Rosset RM eds. Quality of life assessment and application . Boston: MTP Press Ltd, 1988: 181-203.
Stark RDDyspnoea: assessment and pharmacological manipulation. Eur Respir J1988; 1: 280-87.
9.
Davidson AC, Leach R., George Rjd, Geddes DMSupplemental oxygen and exercise ability in chronic obstructive airways disease . Thorax1988; 43: 965-71.
10.
Hinton JMThe physical and mental distress of the dying. Q J Med1963; 32: 1-21.
11.
Higginson I., McCarthy M.Measuring symptoms in terminal cancer: are pain and dyspnoea controlled?J R Soc Med1989; 82: 264-67.
12.
Hayes JCPatients' symptoms and family coping. Cancer Nursing1986; 9: 317-25.
13.
Cassileth BR, Cassileth PAClinical care of the terminal cancer patient. Philadelphia : Lea & Febiger, 1982.
14.
Twycross RG, Lack SATherapeutics in terminal cancer. London: Pitman, 1984.
15.
Gray G., Adler D., Fleming C., Brescia F.A clinical data base for advanced cancer patients. Cancer Nursing1988; 11: 77-83.
16.
Santiago TV , Remolina C., Scoles III V, Edelman NH. Endorphins and the control of breathing. N Engl J Med1981 ; 304: 1190-95.
17.
Rebuck AS, Kangalee M., Pengelly LD, Campbell Ejm.Correlation of ventilatory responses to hypoxia and hypercapnia. J Appl Physiol1973; 35: 173-77.
18.
Paintal ASThoracic receptors connected with sensation. Br Med Bull1977; 33: 169-74.
19.
Guz A.Respiratory sensation in man. Br Med Bull1977; 33: 175-77.
20.
Aitken Rcb.Measurement of feeling using visual analogue scales. Proc R Soc Med1969; 62: 989-93.
21.
Mahler DA, Wells CKEvaluation of clinical methods for rating dyspnea. Chest1988; 93: 580-86.
22.
Wasserman K. , Casaburi D.Dyspnea: physiological and pathophysiological mechanisms. Ann Rev Med1988; 39: 503-15.
23.
Paintal ASThe mechanism of excitation of type J receptors and the J reflex. In: Breathing: Hering-Breuer centenary symposium. London: Churchill, 1970.
24.
Guz A., Noble Mim, Eisele JH, Trenchard D.Experimental results of vagal block in cardiopulmonary disease. In: Breathing: Hering-Breuer centenary symposium. London: J & A Churchill, 1970.
25.
Critchlow V. , Euler C.Intercostal muscle spindle activity and its gamma motor control. J Physiol1963; 108: 820-47.
26.
Campbell Ejm , Howell Jbl.The sensation of breathlessness. Br Med Bull1963; 19: 36-40.
27.
Estenne M.Yernault JC, De Troyer A.Mechanism of relief of dyspnea after thoracocentesis in patients with large pleural effusion. Am J Med1983; 74: 813-18.
28.
Wise SP, Tanji J.Neuronal responses in sensorimotor cortex to ramp displacements and maintained positions imposed on hindlimb of the unanesthetized monkey. J Neurophysiol1981; 45; 482-500.
29.
Marsden CD, Merton PA, Morton HBStretch reflex and servo action in a variety of human muscles. J Physiol1976; 259: 531-60.
30.
Homma L., Obata T, Sibuya.Gate mechnisms in breathlessness caused by chest wall vibration in humans . J Appl Physiol1984; 56: 8-11.
31.
Irsingler GB , Severinnghaus JWClinical problems of ventilatory control. Ann Rev Med1980; 31: 109-26.
32.
Berger AJ, Mitchell RA, Severinghaus JWRegulation of respiration. N Engl J Med1977 ; 14: 92-97.
33.
Duffin J.The chemical regulation of ventilation. Anaesthesia1971; 26: 142-50.
34.
Lugliani R. , Whipp BJ, Seard C., Wasserman K.Effect of bilateral carotid-body resection on ventilatory control at rest and during exercise in man. N Engl J Med1971; 285: 1105-11.
35.
Anonymous.The enigma of breathlessness. Lancet1986; i: 891-92.
36.
Noble Mim, Eisele JH, Trenchard D., Guz A.Effect of selective peripheral nerve blocks on respiratory sensations. In: Hering-Breuer centenary symposium. London: J & A Churchill, 1970.
37.
Comroe JHSome theories of mechanisms of dyspnea. In: Howell JBL, Campbell EJM eds, Breathlessness. Oxford: Blackwell , 1966.
38.
Burns BH, Howell Jbl.Disproportional severe breathlessness in chronic bronchitis. Q J Med1969; 38: 277-94.
39.
Borg G.Psychophysical bases of perceived exertion. Med Sci Sports Exerc1982; 14: 377-81.
40.
Killian KJAssessment of dyspnea. Eur Respir J1988; 1: 195-97.
41.
Adams L., Lane R., Shea SA et al. Breathlessness during different forms of ventilatory stimulation: a study of mechanisms in normal subjects and respiratory patients. Clin Sci1985; 69: 663-72.
42.
McGavin CR, Arvinli M., McHardy Gjr.Dyspnoea, disability and distance walked: comparison of estimates of exercise performance in respiratory disease. Br Med J1978; 2: 241-43.
43.
Fletcher CM , Elmes PC, Fairbairn AS, Wood CHThe significance of respiratory symptoms and the diagnosis of chronic bronchitis in a working population. Br Med J1959; 2: 257-66.
44.
Wolkove N., Dajczman E., Colacone A., Kreisman H.The relationship between pulmonary function and dyspnea in obstructive lung disease. Chest1989; 96: 1247-51.
45.
Mahler DA, Matthay RA, Snyder PE, Wells CK, Loke J.Sustained release theophylline reduces dyspnea in nonreversible obstructive airway disease. Am Rev Respir Dis1985; 131: 22-25.
46.
Aubier M., De Troyer A., Sampson M., Roussos C.Aminophylline improves diaphragm contractility. N Eng J Med1981; 305: 249-52.
47.
Nietrzeba RM , Elliot CG, Adams TD, Yeh MP, Yanowitz FGEffects of aminophylline upon the exercise performance of patients with stable chronic airflow obstruction. Bull Eur Physiopathol Respir1984; 20: 361-67.
48.
Murciano D. , Aubier M., Lecocguic Y., Pariente R.Effects of theophylline on diaphragmatic strength and fatigue in patients with chronic obstructive pulmonary disease. N Engl J Med1984; 311: 349-53.
49.
Leblanc P., Bowie DM, Summers E., Jones NL, Killian KJBreathlessness and exercise in patients with respiratory disease. Am Rev Respir Dis1986; 133: 21-25.
50.
Rice KLTreatment of dyspnea with psychotropic agents. Chest1986; 90: 789.
51.
Matthay RA, Berger JH, Loke J.Effects of aminophylline on right and left ventricular performance in chronic obstructive pulmonary disease. Am J Med1978 ; 64: 903-10.
52.
Stark RD, Gamblas SAEffects of salbutamol, ipratropium bromide and disodium cromoglycate on breathlessness induced by exercise in normal subjects. Br J Clin Pharmacol1981; 12: 497-501.
53.
Coleridge JC , Coleridge HMAfferent C fibres and cardiorespiratory reflexes . Am Rev Respir Dis1977; 115: 251-60.
54.
Ritter JM, Barrow SE, Blair IA, Dollery CTRelease of prostacyclin in vivo and its role in man. Lancet1983; i: 317-19.
55.
O'Neill P., Stark RD, Morton PBDo prostaglandins have a role in breathlessness? Am Rev Respir Dis1985; 132: 22-24.
56.
Schiffman GL , Stansbury DW, Fischer CE, Sato RI, Light RW, Brown SEIndomethacin and perception of dyspnea in chronic airflow obstruction. Am Rev Respir Dis1988; 137: 1094-98.
57.
Kronenberg RS, Cosio MG, Stevenson JE, Drage CWThe use of oral diazepam in patients with obstructive lung disease and hypercapnia. Ann Intern Med1975; 83: 83-84.
58.
Woodcock AA , Gross ER, Geddes DMDrug treatment of breathlessness: contrasting effects of diazepam and promethazine in pink puffers. Q J Med1980; 49: 9-20.
59.
O'Neill PA, Morton PB, Stark RDChlorpromazine - a specific effect on breathlessness? Br J Clin Pharmacol1985; 19: 793-97.
60.
Bradley PB, Wolstencroft JH, Hosli L., Avanzino GLNeuronal basis for the central action of chlorpromazine. Nature1966; 212: 1425-27.
61.
Killam KF, Killam EKDrug action on pathways involving the reticular formation. In: Jasper HH, Proctor LD eds, Reticular formation of the brain. Boston: Little Brown, 1958.
62.
Woodcock AA , Gross ER, Gellert A., Shah S., Johnson M., Geddes DMEffects on dihydrocodeine, alcohol and caffeine on breathlessness and exercise tolerance in patients with chronic obstructive lung disease and normal blood gases. N Engl J Med1981; 305: 1611-16.
63.
Reigl F.Diseases of the respiratory organs. Encyclopedia of medical practice. London: Samson Law, 1976: 523-86.
64.
Powell DR, Hartly PHDiseases of lungs and pleurae. London: HK Lewis, 1911: 126-48.
65.
West S.Diseases of the organs of respiration. London: Charles Griffin, 1909: 200-17.
66.
Vismara LA, Leaman DM, Zelis R.The effects of morphine on venous tone in patients with acute pulmonary edema . Circulation1976; 54: 335-37.
67.
Doyle D.Palliative care: the management of far advanced illness. London: Croom Helm, 1984.
68.
Timmis AD, Rothman MT, Henderson MA, Geal PW, Chamberlain DAHaemodynamic effects of intravenous morphine in patients with acute myocardial infarction complicated by severe left failure. Br Med J1980; 280: 980-82.
69.
Robin ED, Cross CE, Zelis R.Pulmonary edema. N Engl J Med1973; 288: 292-304.
70.
Santiago TV , Johnson J., Riley DJ, Edelman NHEffects of morphine on ventilatory response to exercise. J Appl Physiol1979; 47: 112-18.
71.
Weill JV, McCullough RE, Kline JS, Sodal IEDiminished ventilatory response to hypoxia and hypercapnia after morphine in normal man. N Engl J Med1975; 292: 1103-106.
Ward JM, McGrath RL, Weill JVEffects of morphine on the peripheral vascular response to sympathetic stimulation . Am J Cardiol1972; 29: 659-66.
74.
Young IH, Daviskas E., Keena. Effects of low dose nebulised morphine on exercise endurance in patients with chronic lung disease. Thorax1989; 44: 387-89.
75.
Light RW, Muro JR, Sato RI, Stansbury DW et al. Effects of oral morphine on breathlessness and exercise tolerance in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis1989; 139: 126-33.
76.
Stark RD, Morton PB, Sharman P., Percival PG, Lewis JAEffects of codeine on the respiratory responses to exercise in healthy subjects . Br J Clin Pharmacol1983; 15: 355-59.
77.
Robin ED, Burke CMSingle-patient randomized clinical trial, opiates for intractable dyspnea . Chest1986; 90: 888-92.
78.
Ventafridda V., Spoldi E., De Conno F.The control of dyspnea in advanced cancer patients. Chest1990; 98: 1544-45.
79.
Winning AJ, Hamilton RD, Shea SA, Knott C., Guz A.The effect of airway anaesthesia on the control of breathing and the sensation of breathlessness in man. Clin Sci1985; 68: 215-25.
80.
Winning AJ, Hamilton RD, Guz A.Ventilation and breathlessness on maximal exercise in patients with interstitial lung disease after local anaesthetic aerosol inhalation. Clin Sci1988; 74: 275-81.
81.
Howard P., Cayton RM, Brennen SR, Anderson PBLignocaine aerosol and persistent cough. BrJDis Chest1977; 71: 19-24.
82.
Cowcher K., Hanks GWLong-term management of respiratory symptoms in advanced cancer. Journal of Pain and Symptom Management1990; 5: 320-30.
83.
Stark RD, O'Neill PA, Russell Njw, Heapy CG, Stretton TBEffects of small particle aerosols of local anaesthetic on dyspnoea in patients with respiratory disease. Clin Sci1985; 69: 29-36.
84.
McAlpine LG , Thompson NCBronchoconstriction induced by nebulized lignocaine in asthmatic patients. Thorax1988; 43: 260P.
