Which of the following classes of medications is most likely to relieve sensations of air hunger/dyspnea?
Multiple systematic reviews have demonstrated the effectiveness of various opioids (compared with placebo) for relief of dyspnea whose cause cannot be corrected. Effective relief can be achieved with doses as low as 10 mg daily of oral morphine, and a ceiling effect is observed beyond 30 mg daily of oral morphine. A recent Cochrane review suggested insufficient evidence to recommend the routine use of benzodiazepines for dyspnea. One might consider the use of a benzodiazepine in the presence of clear concomitant anxiety that is significantly contributing to the patient’s experience of dyspnea, after an opioid has received a reasonable therapeutic trial. Little evidence supports the use of antipsychotics or anticonvulsants for this indication.
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