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©2013 UpToDate ® Print Email American Thoracic Society Guidelines for the treatment of dyspnea Mild dyspnea Moderate dyspnea Severe dyspnea Treat underlying disease* Treat psychosocial factors • Treat underlying disease Treat psychosocial factors Pulmonary rehabilitation Δ Consider anxiolytic Treat underlying disease Treat psychosocial factors Pulmonary rehabilitation Facial cooling (by use of fan) Opioids ◊ Anxiolytics Noninvasive ventilation * Treat underlying disease includes anemia, pleural effusions, congestive heart failure, reversible airway obstruction, hypoxemia, main stem bronchial compression or obstruction. • Treat psychosocial factors: For anxiety, use relaxation techniques, distraction, activity modifications, behavior modifications, and breathing strategies. For depression, use cognitive therapy, antidepressants, or a combination of both. Δ Pulmonary rehabilitation includes exercise training, psychosocial support, nutritional therapy, and self-management education, including breathing strategies, use of supplemental oxygen, pharmacologic therapy (to relieve airways obstruction), and panic control. ◊ Evidence indicates that they do not cause premature death in end-of-life patients when titrated to relieve pain or dyspnea. Reprinted with permission of the American Thoracic Society. Copyright © 2008 American Thoracic Society. Lanken PN, Terry PB, DeLisser HM, et al. An Official American Thoracic Society Clinical Policy Statement: Palliative Care for Patients with Respiratory Diseases and Critical Illnesses. American Journal of Respiratory Critical Care Medicine 2008; 177:912. Official Journal of the American Thoracic Society.