Today let me talk about respiratory palliative care.
Many patients of chest diseases suffer from chronic and progressive diseases which ultimately lead to end stage respiratory failure.
What matters in the end?
Most important is to understand what they are going through and relieve the symptoms in the best possible way.
Most common symptoms for these patients are shortness of breath which may be perceived as panic, anxiety and fear of dying.
It is important first of all to rule out possible reversible causes of these symptoms which may include condition line fluid in the lung in form of pulmonary edema for which diuretics can be started or pleural effusion which can be dealt with pleural tapping or more permanent solution can be insertion of an indwelling catheter or intercostal drain.
Another important cause can be central airway obstruction especially in malignant patients which can be dealt with various newer techniques like endobronchial coring, laser resection, followed by stenting.
For irreversible causes relaxation techniques, hand held fan, oxygen supplementation in cases of hypoxia, NIV in cases of Hypercapnia and in further escalation of care opioids and benzodiazepines can be used.
It is important to have a detailed discussion with the patient and caregivers about the expectations and escalation of care!