Effective management of breathlessness: a review of potential human rights issues

Chronic breathlessness is a distinct clinical syndrome defined as “breathlessness that persists despite an optimal use of the therapeutic resources available to treat the underlying causative condition” [1, 2]. This is a frequent clinical condition encountered in chronic respiratory diseases, cardiac diseases, neuromuscular disorders, terminal cancers, whether respiratory or not, and in patients receiving mechanical ventilation for acute or chronic respiratory failure. The above definition includes not only chronic conditions, but also acute breathlessness that persists despite maximal pathophysiological treatment. The term “persistent” breathlessness has been proposed to encompass both acute and chronic situations [2]. Persistent or not, breathlessness is under-recognised by respiratory physicians, particularly in settings of advanced palliative care or intensive care, where verbal communication is difficult [3, 4], thereby leading to calls for greater awareness of this problem [5, 6]. Currow et al. [7] have pointed to the need to assess and treat chronic breathlessness with opioids as outlined in specialist clinical guidelines and argued that failure to do so is a breach of human rights. In this editorial, I expand further on this issue in the hope of clarifying potential moral and human rights issues in proper clinical management of chronic breathlessness or breathlessness in general. As breathlessness is an intensely traumatic event, the issue of proper psychological care of patients is also briefly addressed. Failure to assess and treat breathlessness properly may raise moral and human rights issues <http://ow.ly/v2BN30be8a7> Thanks are due to Thomas Similowski for his valuable comments on the manuscript. This article was prepared as part the author's research and knowledge dissemination programme supported by Spunk Fund, Int.