Bio-sketch
David Currow is Professor of Palliative and Supportive Services at Flinders University, Adelaide where more than 350 distance students from around the world study palliative care at a post-graduate level. Research includes clinical trials, population-based planning and codifying the evidence base underpinning palliative care. Research funders include the National Health and Medical Research Council and the National Institutes of Health (USA).
He is the principal investigator for the Palliative Care Clinical Studies Collaborative (PaCCSC) which has randomised more than 1250 palliative care patients across 12 sites to phase III symptom control studies. He is also co-principal investigator on www.caresearch.com.au, an anthology of evidence in palliative care. He is a foundation partner in the Australian Palliative Care Outcomes Collaborative, an initiative to systematically improve clinical outcomes in palliative care.
David has published more then 290 peer-reviewed articles, editorials and books. He is senior associate editor of Journal of Palliative Medicine and on the editorial boards of Journal of Pain and Symptom Management, BMJ Supportive and Palliative Care and the Journal of Oncology Practice. David is a former president of Palliative Care Australia and the Clinical Oncological Society of Australia.
David also holds the positions of Chief Cancer Officer, New South Wales and Chief Executive Officer of the state’s cancer control agency, the Cancer Institute, New South Wales.
Abstract
Breathlessness is a distressing symptom that, unlike many other symptoms, worsens as death approaches. It is distressing for patients, their families and for the professional carers. The modulation of breathlessness includes perceptions of both intensity (severity) and in terms of unpleasantness (the affective component). Each of these needs to be considered in both a research and clinical setting.
Breathlessness shares many similarities with pain: its temporal patterns; its subjective nature; its genesis; generation transmission interpretation and response and the distress that it causes and that it shares the limbic system as a major integrator of neural information.
The evidence base for assessing and treating breathlessness has progressed rapidly in the last decade. Evidence does exist that opioids are efficacious and growing evidence supports their safety. A number of other pharmacological agents are being prospectively studied in rigorously designed phase III trials. A number of non-pharmacological interventions have shown benefit across a wide range of underlying etiologies. Oxygen therapy has not been shown to have symptomatic benefit over and above medical air in people who currently do not quality for long term oxygen therapy. The one exception may be in people with chronic obstructive pulmonary disease.
Overall, much can be done to diminish the impact of breathlessness and to improve people’s quality of life even when functional status is markedly impaired because of that breathlessness.
References
Abernethy AP, Currow DC, Frith P, et al. Randomised double-blind placebo-controlled crossover trial of sustained-release morphine for the management of refractory dyspnoea. Br Med J 2003(7414);327:523-25.
Jennings AL, Davies AN, Higgins JPT, et al. A systematic review of the use of opioids in the management of dyspnoea. Thorax 2002;57:939-944.
Abernethy AP, McDonald CF, Frith PA, et al. Effect of palliative oxygen versus room air in relief of breathlessness in patients with refractory dyspnoea: a double-blind randomized controlled trial (NCT00327873). Lancet 2010;376(9743):784-793.
Currow DC, McDonald C, Oaten S, et al. Once-daily opioids for chronic dyspnoea: a dose increment and pharmacovigilance study. J Pain Symptom Manage 2011;42(3):388-399
Uronis HE, Currow DC, McCrory DC, et al. Oxygen for relief of dyspnoea in mildly- or non-hypoxaemic patients with cancer: a systematic review and meta-analysis. Br J Cancer 2008;98(2):294-299.
Uronis H, McCrory DC, Samsa G, et al. Symptomatic oxygen for non-hypoxaemic chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2011 Jun 15;6:CD006429.
Mahler DA, Murray JA, Waterman LA, et al. Endogenous opioids modify dyspnoea during treadmill exercise in patients with COPD. Eur Resp J 2009;33:771-777.
Dudgeon D, Lertzman M. Dyspnea in the advanced cancer patient. J Pain Symptom Manage 1998; 16:212-219
