Regardless of aetiology, dyspnoea is one of the most common symptoms reported by patients with advanced disease who are nearing the end of life. Because of the complex ventilatory, biochemical and psychological causes, dyspnoea presents a challenging symptom to manage in this group of patients. Dyspnoea or breathlessness is largely a subjective symptom and difficult to quantify, but despite this, the symptom can be overwhelming for patients. It may range from feeling uncomfortable and aware of their breathing, associated with physical exertion, or through to a highly anxious and fearful experience at rest. This may be further exacerbated as breathless patients withdraw from family and friends by limiting conversations, activities and social interactions as a result of their continual fight to breathe. 

 

Initial management of dyspnoea seeks to concurrently address the symptom while identifying and treating any underlying causes. When, however, these causes are no longer reversible, symptom relief becomes the main objective of care. Treatment can be balanced between pharmacological and non-pharmacological interventions with a focus on individual patient centric and holistic care paradigm with dyspnoea management a central part of the of the care matrix. 

 

One potential non-pharmacologic strategy that may improve patient comfort and relieve symptoms associated with breathlessness is nasal high flow therapy (NHF). NHF provides heated and humidified gas/air ± oxygen which acts to improve secretion clearance and reduce metabolic workload. In patients with respiratory distress and failure, NHF has demonstrated reductions in patient’s work of breathing, respiratory rate while improving tolerance and comfort. The mechanisms of actions may also provide similar symptom relief in palliative care enhancing quality of life, decreasing symptom burden, increasing patient alertness and enriched patient and family interactions during end of life care processes. This presentation seeks to outline the potential benefit of NHF maximising comfort for various stages of the palliative care timeline.