Which symptoms of respiratory dysfunction can be alleviated without ventilators?

Respiratory weakness (hypoventilation) or narrowing of the airways (obstruction) can be associated with various symptoms and complaints.

Typical symptoms of hypoventilation include labored breathing (dyspnea) as well as fatigue, tiredness, and even drowsiness. These latter symptoms are caused by a buildup of carbon dioxide in the blood.

Airway obstruction caused by secretions in the throat, pharynx, or bronchi can be experienced as sudden and severe labored breathing or a “shortness of breath.” It is caused by “choking” on one’s own saliva, a buildup of secretions in the mouth, or difficulty effectively coughing up bronchial secretions.

The symptoms of obstruction are often perceived as distressing and require treatment with mucolytic or suppressant medications. Certain morphine preparations are particularly suitable, as they provide palliative relief.

Morphine and other palliative care medications may be associated with a “double effect.” This means that while these medications provide symptom relief, they may also shorten the patient’s remaining lifespan.

Palliative medications may shorten life expectancy when respiratory function is already severely impaired by ALS and the sedative effect of the medication leads to a further decline in respiratory function. As a result, the medications can cause drowsiness (sedation), which in some cases may also increase the body’s carbon dioxide buildup and accelerate the process of dying—a process that, without medication, would have occurred somewhat later.

Before starting treatment with palliative medications (e.g., morphine and benzodiazepines), patients and their families should be informed about and counseled on the potential dual effect.