What pharmacological treatment options are available for dyspnea?

Reduced strength of the respiratory muscles (hypoventilation) can lead to increased breathing effort (dyspnea). The treatment of dyspnea primarily involves the use of respiratory support devices (respiratory support via mask ventilation or cough assist devices). In certain situations, respiratory devices cannot be used, or the patient may prefer to forgo technical support measures (and the associated costs).

In this situation, medications are used to reduce the subjective experience of breathing difficulty. Benzodiazepines (such as lorazepam or diazepam) may be considered for the treatment of dyspnea. These are sedatives (“calming medications”) that, while unable to increase respiratory strength, are effective in alleviating the subjective sensation of breathing difficulty. In this sense, these medications should be understood as “sedatives” for dyspnea.

In cases of severe respiratory distress (usually associated with airway obstruction caused by secretions in the throat, pharynx, and bronchi), the use of morphine (in the form of tablets, drops, or subcutaneous injections) can provide relief. Morphine is known for its high efficacy against pain. Through a similar mechanism, these medications can also provide effective and reliable relief from respiratory distress.

In certain situations (e.g., sudden episodes of labored breathing and shortness of breath), there have been positive results with fentanyl, which can be administered as a nasal spray (nasal application) and can provide symptom relief very quickly (within a few minutes). Fentanyl is a synthetic morphine preparation that is more potent than conventional morphine medications. Morphine and fentanyl are subject to the Controlled Substances Act and are prescribed by specialists with experience in morphine treatment in the field of palliative care. The decision to use benzodiazepines and morphine is primarily determined by the severity of the symptoms, the patient’s tolerance for potential side effects (e.g., drowsiness from benzodiazepines or constipation from morphine), and the individual treatment goal. These medications are primarily used when the treatment goal is palliative symptom relief.