Purpose of review: This paper reviews the current evidence for the pharmacological treatment of refractory symptomatic breathlessness in people with advanced life-limiting illnesses. The paper does not explore changes in function.
Recent findings: Oral and parenteral opioids reduce dyspnoea, and data continue to add to this indication for these drugs. Optimal dosing of opioids is being refined. Interest in other medications continues to be explored - benzodiazepines, nebulised frusemide, and selective serotonin reuptake inhibitors - but their role in day-to-day clinical practice is not defined.
Summary: Low-dose regular opioids, especially sustained-release preparations, have a key role in the pharmacological management of dyspnoea when titrated for effect, and may be used regularly across a range of underlying pathophysiologies. Key research questions for all the current symptomatic pharmacological agents used in refractory dyspnoea remain.