We thank our correspondents for emphasizing that the therapeutic recommendations in our article are related to refractory dyspnea and cough, as mentioned in our subheadings and the introduction.
Our corresponding colleagues support our opinion that potentially reversible causes of shortness of breath and cough need to be identified in order to be able to use all causal therapeutic options. A number of diagnostic measures are available to this end. We think that a comprehensive differential diagnostic evaluation is the remit of the leading medical specialty (for example, oncology, pneumology) and therefore restricted ourselves to selected examples of diagnostics from the perspective of palliative medicine. Close collaboration among the different specialties is important while recognizing one another’s technical competence, and, in our experience, this has become a good tradition in palliative medicine—entirely in the sense of an “interdisciplinary treatment approach.”
Specific local therapeutic options, such as the mentioned radiotherapy or bronchoscopy are among the disease-specific options that should already have been exhausted or should not be indicated in refractory dyspnea.
As we explained in detail in our sections on history taking and evaluation and general measures, the different aspects of communication with patients and their families are a crucial component in caring for patients with refractory dyspnea. This ranges from careful listening, to the question of whether a patient or family member is experiencing any psychological distress, to showing options for tackling dyspnea and creating and explaining an emergency plan. The suggestion of “preventive” communication is helpful if it is foreseeable that a patient will develop dyspnea.
Prof. Dr. med. Claudia Bausewein PhD MSc
Klinik und Poliklinik für Palliativmedizin
Klinikum der Universität München
Dr. med. Steffen Simon MSc
Zentrum für Palliativmedizin
Conflict of interest statement
Prof. Bausewein has received support for a research project that she initiated from the National Institutes of Health Research (NIHR) and from Cicely Saunders International. She has received payment for preparing continuing medical education events from the Association for Lung Disease and Tuberculosis (Verein zur Förderung der Lungen- und Tuberkuloseheilkunde), the Evangelische Lungenklinik in Berlin and the Health Professions Education Center and Doctors’ Academy (Bildungszentrum für Gesundheitsberufe mit Ärzteakademie) in Hamburg. She has received reimbursement of conference participation fees and travel and accommodation costs from the European Association for Palliative Care, the German Association for Palliative Medicine (Deutsche Gesellschaft für Palliativmedizin), and the German Respiratory Society (Deutsche Gesellschaft für Pneumologie).
Dr. Simon has received funding from TEVA for a research project that he initiated.
|1.||Bausewein C, Simon ST: Shortness of breath and cough in patients in palliative care. Dtsch Arztebl Int 2013; 110(33–34): 563–72 VOLLTEXT|