Medication for Dyspnea

Philipp von Trott, Johannes Rosenbruch

Last update: 14.10.2018

Medications to treat dyspnea are selected based on the underlying manifestation of the disease, the symptoms experienced by the patient, the accompanying anxiety, and finally the aim of strengthening the patient’s individual capacities for dealing with the disease. In addition to treating the symptoms, there should be optimal treatment of the underlying disease and an investigation of potentially reversible causes. This should be done in close coordination with the respective specialists in oncology, pulmonology, radiation therapy.

Depending on the cause, additional interventional procedures may be considered—pleural puncture, pleurodesis, pericardiocentesis for pericardial effusion, bronchoscopic interventions, radiation therapy, oxygenation and (non-)invasive ventilation.

Common drugs for the treatment of dyspnea, such as opiates, are effective, but their use may be limited due to side effects such as nausea, constipation and sedation. Anthroposophic medicinal products can be used as an initial treatment for shortness of breath or as supplementary medication to reduce the opiate dose.

  • Basic therapy
    Carbo Betulae D6–D20 amp. WELEDA (also available as Carbo vegetabilis), 1 amp. s.c., repeat if necessary (applies to all potencies mentioned) 
    Onset of effect: after 1-3 injections calmer breathing, improvement of anxiety and dyspnea 

  • For anxiety and fear
    Bryophyllum 50% trit. WELEDA, 3 x/d 0.5 tsp.
    Bryophyllum D5/Conchae D7 aa 10 ml amp. WELEDA, if required up to several times a day i.v.

  • Dyspnea with pneumonia/inflammatory infiltrates
    Pulmo/Vivianit comp. amp. WALA, 1 x/d 1 amp. i.v. or s.c. between the shoulder blades
    Composition: Bryonia cretica D5, Pulmo bovis Gl D16, Tartarus stibiatus D7, Vivianit D7
    Onset of effect: improves dyspnea within a few days 
    Duration of treatment: 1 week
    Concomitant therapy:
    Pneumodoron® 1 dil. WELEDA, 3 x/d 20 drops
    Composition: Aconitum napellus D2, Bryonia D2.
    Pneumodoron® 2 dil. WELEDA, 3 x/d 20 drops
    Composition: Phosphorus D4, Tartarus stibiatus D2.

  • Prolonged expiration/bronchospasm/obstruction
    Cuprum aceticum comp. amp. WALA, 1–2 x/d amp. s.c. between the shoulder blades in the morning and if necessary in the evening
    Composition: Cuprum aceticum D5, Nicotiana tabacum e foliis D9, Renes bovis Gl D5.
    Onset of effect: the same day
    Also for dry chesty coughs (Cuprum aceticum D4 dil. WELEDA, 3 x/d 20 drops)

  • Mucopurulent obstructive bronchitis with thick secretions
    Tartarus stibiatus D6, D4 trit. WELEDA, 3 x/d 1 saltsp.
    Camphora D3, D6 dil. magistral prescription (e.g., from Apotheke an der Weleda), 3 x daily 20 drops
    Oleum camphoratum comp. amp. WALA amp., 1 x/d morning i.m./s.c.
    Composition: D-Camphora, Eucalypti aetheroleum, Pini aetheroleum, Terebinthinae aetheroleum rectificatum.

  • Dyspnea with pulmonary venous congestion, in addition to diuretic medication
    Carbo Betulae D8/Crataegus D2 aa amp. WELEDA, s.c.

  • Lymphangitis carcinomatosa
    Inhalations with Helleborus D4 amp. WALA
    Rose Iron/Graphite dil. WELEDA, 3 x/d 20 drops
    Composition: Ferrum rosatum D2, Ferrum sidereum D1.
    Prednisolone for symptomatic therapy

  • Persistent coughing
    Plexus pulmonalis D15 amp. WALA, s.l. or s.c.

  • Patients with existing opioid therapy
    Leave as is, if necessary increase + 1/6 of the daily dosage as a fast-acting form: approx. every 4 hours (e.g., drops) or s.c./i.v. as a short infusion (if necessary max. every 30 minutes). A titration of the necessary dose is required.

  • Opioid naïve patients
    Where possible, oral medication should be preferred to maintain patient autonomy. It is a titration of morphine sol. 2%, for non-oncological patients 1–2 drops = 1.25–2.5 mg , for oncological patients 2–4 drops = 2.5–5 mg per os every 4 hours (can be repeated after 30 min. if required).

    In addition, constipation prophylaxis must be considered in opioid patients with chronic opioid administration. Medicinal products containing bitter substances have proven their worth, such as
    Gentiana 5% dil. WALA or
    Chelidonium WALA/WELEDA

    If oral administration is no longer possible, a titration with morphine 1 mg s.c./i.v. is started as a short infusion every 4 hours (can be repeated after 30 min., if necessary). A changeover to continuous delivery via a pump is desirable. Alternatively, a transdermal application can also be performed (e.g., fentanyl, buprenorphine). In case of kidney insufficiency, an opioid rotation to hydromorphone 0.5 mg s.c./i.v. should be performed as a short infusion, starting from morphine 1.5 mg s.c./i.v. (cumulative dose).

  • Opioids should be applied together with
    Aurum metallicum praeparatum D10 amp. WELEDA. 

Research news

Phase IV trial: Kalium phosphoricum comp. versus placebo in irritability and nervousness 
In a new clinical study, Kalium phosphoricum comp. (KPC) versus placebo was tested in 77 patients per group. In a post-hoc analysis of intra-individual differences after 6 weeks treatment, a significant advantage of KPC vs. placebo was shown for characteristic symptoms of nervous exhaustion and nervousness (p = 0.020, p = 0.045 respectively). In both groups six adverse events (AE) were assessed as causally related to treatment (severity mild or moderate). No AE resulted in discontinuation in treatment. KPC could therefore be a beneficial treatment option for symptomatic relief of neurasthenia. The study has been published open access in Current Medical Research and Opinion

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