Medication for Dyspnea

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.