Management of Breathlessness

Initial Assessment

For patients with breathlessness and SpO2 of 93%, supplemental oxygen therapy is not routinely required as this saturation level is within normal range, according to the British Thoracic Society 1, 2
Evaluate for underlying causes of breathlessness despite relatively normal oxygen saturation, as recommended by the American Thoracic Society 2
Check vital signs including respiratory rate, heart rate, and blood pressure to assess severity, as suggested by the American College of Physicians 3
Consider arterial blood gas (ABG) measurement if there is clinical concern about hypercapnia or if the patient appears more unwell than the SpO2 suggests, as recommended by the British Thoracic Society 1, 2

Target oxygen saturation range of 94-98% for patients without risk of hypercapnic respiratory failure, as recommended by the British Thoracic Society 1, 2
For patients with risk of hypercapnic respiratory failure, target oxygen saturation range of 88-92%, as recommended by the American Thoracic Society 1, 2
Risk factors for hypercapnic respiratory failure include COPD, cystic fibrosis, neuromuscular disease, chest wall deformities, and morbid obesity, as identified by the American College of Chest Physicians 2

Consider a hand-held fan as first-line treatment for breathlessness when oxygen saturation is normal, as recommended by the British Thoracic Society 1, 4
Early involvement of physiotherapists for breathing techniques and positioning, as suggested by the American Thoracic Society 4
Position patients to optimize ventilation (upright position if possible), as recommended by the British Thoracic Society 1
For pregnant women above 20 weeks gestation, use left lateral positioning to avoid aortocaval compression, as recommended by the American College of Obstetricians and Gynecologists 1

Low-dose opioids should be considered for relief of breathlessness, particularly in palliative care settings, as recommended by the British Thoracic Society 1, 4
Treat anxiety which may contribute to sensation of breathlessness, as suggested by the American Psychiatric Association 4

In palliative care settings, oxygen therapy should be restricted to patients with SpO2 consistently <90% or those reporting significant relief from oxygen, as recommended by the British Thoracic Society 1, 4
Non-pharmacological measures and opioids should be tried before oxygen in non-hypoxemic patients, as suggested by the American Academy of Hospice and Palliative Medicine 4
Oxygen therapy should not be continued in the absence of patient benefit, as recommended by the British Thoracic Society 4

Record oxygen saturation, delivery system, and flow rate on patient monitoring charts, as recommended by the American College of Physicians 2
Reassess frequently if breathlessness persists despite normal oxygen saturation, as suggested by the American Thoracic Society 2
Consider urgent clinical reassessment if oxygen requirements increase, as recommended by the American College of Emergency Physicians 2