Abstract
Dyspnea is a common and highly distressing symptom in patients with advanced illnesses.
Many patients continue to experience chronic dyspnea despite optimal management of
underlying disease(s) and various non-pharmacologic interventions, necessitating the
consideration of pharmacologic therapies for palliation of dyspnea. One commonly asked
question by clinicians is whether benzodiazepines have a role in the palliation of
dyspnea. In this “Controversies in Palliative Care” article, three groups of thought
leaders independently answer this question. Specifically, each group provides a synopsis
of the key studies that inform their thought processes, share practical advice on
their clinical approach, and highlight the opportunities for future research. All
three groups suggest that benzodiazepines alone do not confer a benefit for dyspnea
in advanced illnesses based on existing data. They also expressed concerns about the
potential adverse effects such as delirium and drowsiness and recommended against
benzodiazepines as first line pharmacologic therapy. Some groups suggest that benzodiazepines
may be used in highly selected patients with severe anxiety associated with dyspnea.
Some investigators may also consider the adjunctive use of benzodiazepines in patients
with severe dyspnea despite opioids, particularly if life expectancy is limited. Benzodiazepines
also have a role in palliative sedation for refractory dyspnea in the last days of
life. More research is needed to confirm the benefit of benzodiazepines in these populations.
Key Words
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Article info
Publication history
Published online: November 28, 2022
Accepted:
November 19,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
