A patient presents with significant shortness of breath from a COPD exacerbation. His room air saturation is 80%, respiratory rate of 30, and is uncomfortably seated in a tripod position. You administer the usual regimen:
- Oxygen by face mask
- Nebulized albuterol and atrovent
- Set up for possible intubation
With the Bipap mask on, the patient’s subjective sense of dyspnea and “air hunger” seems to make it harder for him to tolerate the tight-fitting mask.
Trick of the Trade: Opioids for air hunger
Use a small dose of IV fentanyl
A 2001 Cochrane review evaluated studies involving non-nebulized opioids to treat symptomatic breathlessness. The review found a small statistically significant improvement in subjective air hunger, although most studies were with small sample size numbers.