My Brother Has Severe Emphysema. What Can We Do To Help Him?

My brother has severe emphysema, is on oxygen, and has just started hospice.  He panics almost daily from his shortness of breath.  What can we do to help him?
For patients with a life-limiting disease like emphysema (aka COPD—Chronic Obstructive Pulmonary Disease), or like CHF (congestive heart failure), often the most distressing symptom they have is shortness of breath. 
They tell me they fear they will ‘smother to death’.  There are many things our hospice and hospital palliative care teams can do to improve their comfort and minimize the sensation of  ‘smothering’.
The following, alone or in combination, have all been found to be beneficial.

  • Morphine.  This is the most helpful drug (although many families are afraid it might cause addiction, hallucinations, sedation].   Almost every patient with shortness of breath eventually takes morphine (or, another equivalent narcotic, like hydromorphone [Dilaudid]).  Most folks then say, “I wish I had started this sooner”, because a small dose taken regularly improves dramatically their quality of life:  less shortness of breath, less anxiety, less pain overall, and sleeping better.
  • Anxiety-reducing medications.  Because patients are worrying whether they’ll be able to take another breath, an anti-anxiety drug, like lorazepam [Ativan], can be combined with the morphine and together have an even bigger benefit.
  • Avoiding drugs which make anxiety worse.  Most folks are using an inhaler or nebulizer with albuterol, to open their airways and reduce wheezing.  Unfortunately, this drug also can cause the ‘jitters’ and make their anxiety worse.  Switching to atrovent or tiotropium can avoid the ‘jitters’.
  • Oxygen.  A patient’s sensation of shortness of breath is often unrelated to their “percentage oxygen”:  many folks are comfortable with an 85% oxygen reading while others need to be 96%.  Oxygen is not always necessary for comfort.
  • A fan.  A fan blowing into their face helps reduce the feeling of lack of air.
  • Avoiding a closed room – keep the door open to the hallway and the window blinds open:  this will help avoid the claustrophobia these folks frequently experience.

A family can initiate any of these helpful actions and make everyone’s life better; and when people with such a life-limiting disease feel better, they usually live longer!