Prescribing guidance for shortness of breath

Shortness of breath is a subjective symptom relating to breathing discomfort. There may be a psychosocial component to shortness of breath. For the specific management of someone with anxiety associated with shortness of breath, refer to anxiety and emotional distress.

Opioid naïve

1. Prescribe an opioid for shortness of breath, consider:
• morphine - 1.5mg to 2.5mg SC PRN every 2 hrs (PBS)
  OR
• fentanyl - 25micrograms to 50micrograms SC PRN every 2 hrs
  OR
• HYDROmorphone - 0.25mg to 0.5mg SC PRN every 2 hrs (PBS)
 
2. If shortness of breath present administer opioid PRN dose
3. Assess effectiveness of administered medicine and continue administering opioids as required

Opioid tolerant

1. Review current opioid dose:
   • If the patient is using regular opioids and is unable to swallow, consider converting regular oral opioids to appropriate SC dose administered by CSCI using syringe driver over 24 hrs
   • If the patient is very distressed and/or if multiple PRN opioids administered in previous 24 hours to manage shortness of breath, consider:
     • calculating the total PRN opioid dose over the previous 24 hours and add to syringe driver
       OR
     • titrating up the opioid dose administered by syringe driver in previous 24 hours by 30%.
       
       
   • ​If opioid patch in situ, consider:
     • continuing at same dose and administer PRN medicine for breakthrough symptoms
       OR
     • converting patch to appropriate SC opioid dose administered by CSCI using a syringe driver.
       
       
   • ​Ensure order written for PRN dose. PRN order = 10% of total daily SC dose, every 2 hrs
    
2. If shortness of breath present, administer opioid PRN dose
3. Assess effectiveness of administered medicine and continue administering opioids as required

Prescribing considerations

• Review patient regularly
• If greater than 3 doses of any PRN medicine are required over a 24 hour period, review and consider changes to medication and syringe driver orders
• Check availability of medicines through the patient’s usual pharmacy

The medicines listed throughout this app are in line with those endorsed by caring at home and the Australian and New Zealand Society of Palliative Medicine (ANZSPM) within the Community End-of-Life Medicines List (168kb pdf).

Page updated 19 July 2018