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Should Benzodiazepines be Used for Reducing Dyspnea in Patients with Advanced Illnesses?

  • Author Footnotes
    ⁎ Contributed equally to this paper as co-first authors.
    Steffen T. Simon
    Footnotes
    ⁎ Contributed equally to this paper as co-first authors.
    Affiliations
    Department of Palliative Medicine and Center for Integrated Oncology (S.T.S., A.P.), University Hospital of Cologne, Cologne, Germany
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  • Author Footnotes
    ⁎ Contributed equally to this paper as co-first authors.
    Masanori Mori
    Footnotes
    ⁎ Contributed equally to this paper as co-first authors.
    Affiliations
    Palliative and Supportive Care Division (M.M.), Seirei Mikatahara General Hospital, Hamamatsu, Japan
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  • Author Footnotes
    ⁎ Contributed equally to this paper as co-first authors.
    Magnus Ekström
    Footnotes
    ⁎ Contributed equally to this paper as co-first authors.
    Affiliations
    Respiratory Medicine, Allergology, and Palliative Medicine (M.E.), Lund University, Sweden
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  • Anne Pralong
    Affiliations
    Department of Palliative Medicine and Center for Integrated Oncology (S.T.S., A.P.), University Hospital of Cologne, Cologne, Germany
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  • Takashi Yamaguchi
    Affiliations
    Department of Palliative Medicine (T.Y.), Kobe University Graduate School of Medicine, Kobe, Japan
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  • David Hui
    Correspondence
    Address correspondence to: David Hui, MD, MSc, Department of Palliative Care, Rehabilitation and Integrative Medicine, Unit 1414 - University of Texas MD Anderson Cancer Centre, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
    Affiliations
    Department of Palliative Care, Rehabilitation and Integrative Medicine (D.H.), The University of Texas MD Anderson Cancer Center, Houston, Texas
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  • Author Footnotes
    ⁎ Contributed equally to this paper as co-first authors.

      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.

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