SERKAN YILMAZ, ELIF YAKA, MELIH YUKSEL, NURETTIN OZGUR DOGAN, MURAT PEKDEMIR
Department of Emergency Medicine, Faculty of Medicine, Kocaeli University, Turkey
Introduction: Dyspnea is a frequent and devastating symptom among patients with cancer, and is a prognostic indicator of survival. The management of cancer-related dyspnea remains a challenge due to lacking systematic guidelines for clinical care. The mainstay of cancer related dyspnea palliation is being considered altering central perception, and morphine is still the first choice of therapy. Conventional management of cancer related dyspnea might not be suitable for emergency department. Palliative treatment of a cancer patient shouldn’t always be planned as end of live care in the ED. There has been no study published that describes the efficacy of bronchodilators or respiratory muscle relaxants inpatients experiencing dyspnea with lung cancer.
The aim of the study was to determine effect of salbutamol, beta 2 agonist and magnesium sulfate, respiratory muscle relaxants for improvement on respiratory capacity in patients with lung cancer.
Methods: This was a randomized, double blind clinical trial. Adult patients with lung cancer, with a Peak Expiratory Flow Rate (PEFR) of <250 L/min, who did not receive bronchodilators and not requiring assisted ventilation were included. Patients were randomized to receive either serial three doses of 2.5 mg salbutamol plus 1500 mg magnesium sulfate in IV 100 mL 0.9% NaCl or serial three doses of 2.5 mg salbutamol plus 100 mL IV 0.9% NaCl. We defined the primary outcome measures as the changes in PEFR and Fischl index over time (at 0 and 120 min).
Results: Salbutamol therapy increased mean PEFR from 127.4 liters/minute to 169.4 liters/minute (p<0.01), while salbutamol plus magnesium therapy increased it from 131.1 to 174.9 liters/minute (p<0.01). Both therapies resulted in improvement in Fischl Scores. After treatment PEFR and Fischl Scores were similar between the two groups (p=0.74, p=0.19).
Conclusion: Optimal management of dyspnea in cancer patients requires an understanding of the causes and decision-making process must consider of the patient’s general condition, the presence and severity of symptoms. The results of this study revealed, salbutamol, a non-opioid, beta 2-agonist agent, provided significant improvement on respiratory capacity in patients with cancer related dyspnea. However, adding IV Magnesium therapy to nebulized salbutamol has no beneficial effect.
dyspnea, cancer, and emergency department