Abstract
Dear Editor:
We have read with great interest the work carried out by Kamal and associates, 1 and wanted to thank the authors for contributing this article, which describes a review of trials assessing all pharmacologic and nonpharmacologic interventions for dyspnea palliation in terminal patients. We would like to make some comments.
It does not mention noninvasive positive pressure ventilation (NPPV, often called BiPAP). NPPV is used in dying patients with dyspnea for palliative purposes. This category includes dying patients who have decided to forego life-prolonging therapies and wish to focus on comfort measures. NPPV can be used to reduce the work of breathing, to ease dyspnea, and to help maintain wakefulness by reducing the amount of opioids a patient needs to be comfortable. 2
It is also surprising that chlorpromazine was not included. 3 In an open-label trial, McIver and colleagues found chlorpromazine to be effective for relief of dyspnea in advanced cancer patients.
We also think it is important to emphasize an aspect that reflects a common clinical practice. Our terminally ill cancer patients who are receiving regular doses of opioids benefit from a supplemental equivalent of 25% to 50% of their 4-h oral or subcutaneous regular opioid dose to improve their breathlessness. 4
At present our group is conducting a Phase II randomized controlled trial to determine the effectiveness of oral transmucosal fentanyl citrate for exertion dyspnea treatment in seriously-ill cancer patients, and to contribute to our knowledge of the use of fentanyl in this population (A randomized cross-over clinical trial to evaluate the efficacy of oral transmucosal fentanyl citrate in the treatment of dyspnea on exertion in patients with advanced cancer. EUDRACT: 2010-021399-26).