Dyspnea (also called shortness of breath or breathlessness) is a common and distressing symptom at the end of life. It is the subjective feeling of breathlessness. The clinical definition of dyspnea is an uncomfortable awareness of one’s breathing effort. The risk for dyspnea at the end of life varies based on the underlying diagnosis. Between 29% and 74% of patients with any terminal illness (Dorman, 2009) and up to 95% of patients with Chronic Obstructive Pulmonary Disease (COPD) experience breathlessness (Campbell, 2010). People with dementia or impaired cognition are at risk for dyspnea but may not be able to communicate that distress. They may be at risk for over and under-treatment of dyspnea unless assessed effectively (Campbell, Templin, 2010). Shortness of breath (SOB) can be functionally limiting and distressing to patients and caregivers. A core goal of hospice is comfort. On the initial visit, evaluating and addressing dyspnea is a core priority.

Why Dyspnea?

• The risk of dyspnea at the end of life varies based on underlying diagnosis, but between 29-74 percent of patients with any terminal illness will experience dyspnea.
• People with dementia may be at risk for over or under treatment unless assessed effectively.
• Dyspnea is functionally limiting and distressing to patients and caregivers.
• The Hospice Item Set requires hospice programs to screen for dyspnea during the initial nursing assessment, and if found to be present, patients must receive treatment within 1 day of the screening.

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