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Consensus Statement |

American College of Chest Physicians Consensus Statement on the Management of Dyspnea in Patients With Advanced Lung or Heart Disease

Donald A. Mahler, MD, FCCP; Paul A. Selecky, MD, FCCP; Christopher G. Harrod, MS; Joshua O. Benditt, MD, FCCP; Virginia Carrieri-Kohlman, DNSc; J. Randall Curtis, MD, FCCP; Harold L. Manning, MD, FCCP; Richard A. Mularski, MD, MSHS, MCR, FCCP; Basil Varkey, MD, FCCP; Margaret Campbell, RN, PhD; Edward R. Carter, MD, FCCP; Jun Ratunil Chiong, MD, FCCP; E. Wesley Ely, MD, MPH, FCCP; John Hansen-Flaschen, MD, FCCP; Denis E. O’Donnell, MD; Alexander Waller, MD
Author and Funding Information

From Dartmouth-Hitchcock Medical Center (Drs Mahler and Manning), Lebanon, NH; Hoag Hospital (Dr Selecky), Newport Beach, CA; the American College of Chest Physicians (Mr Harrod), Northbrook, IL; University of Washington Medical Center (Dr Benditt), Seattle, WA; University of California at San Francisco (Dr Carrieri-Kohlman), San Francisco, CA; Harborview Medical Center (Dr Curtis), University of Washington, Seattle, WA; Kaiser Permanente Northwest (Dr Mularski), Portland, OR; Froedtert Memorial Lutheran Hospital (Dr Varkey), Milwaukee, WI; Detroit Receiving Hospital (Dr Campbell), Detroit, MI; Children’s Hospital & Regional Medical Center (Dr Carter), Seattle, WA; University of Florida (Dr Chiong), Jacksonville, FL; Vanderbilt University School of Medicine (Dr Ely), Nashville, TN; Hospital of the University of Pennsylvania (Dr Hansen-Flaschen), Philadelphia, PA; Queen’s University (Dr O’Donnell), Kingston, ON, Canada; and “Sheba” Medical Center (Dr Waller), Tel Hashomer, Israel.

Correspondence to: Donald A. Mahler, MD, FCCP, Dartmouth-Hitchcock Medical Center, Pulmonary and Critical Care Medicine, One Medical Center Drive, Lebanon, NH 03756-0001; e-mail: Donald.A.Mahler@Hitchcock.org


Funding/Support: This project was commissioned by the American College of Chest Physicians (ACCP) and is considered an official project of this organization.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(3):674-691. doi:10.1378/chest.09-1543
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Background:  This consensus statement was developed based on the understanding that patients with advanced lung or heart disease are not being treated consistently and effectively for relief of dyspnea.

Methods:  A panel of experts was convened. After a literature review, the panel developed 23 statements covering five domains that were considered relevant to the topic condition. Endorsement of these statements was assessed by levels of agreement or disagreement on a five-point Likert scale using two rounds of the Delphi method.

Results:  The panel defined the topic condition as “dyspnea that persists at rest or with minimal activity and is distressful despite optimal therapy of advanced lung or heart disease.” The five domains were: measurement of patient-reported dyspnea, oxygen therapy, other therapies, opioid medications, and ethical issues. In the second round of the Delphi method, 34 of 56 individuals (61%) responded, and agreement of at least 70% was achieved for 20 of the 23 statements.

Conclusions:  For patients with advanced lung or heart disease, we suggest that: health-care professionals are ethically obligated to treat dyspnea, patients should be asked to rate the intensity of their breathlessness as part of a comprehensive care plan, opioids should be dosed and titrated for relief of dyspnea in the individual patient, both the patient and clinician should reassess whether specific treatments are serving the goal of palliating dyspnea without causing adverse effects, and it is important for clinicians to communicate about palliative and end-of-life care with their patients.


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