How to manage tachypnea (rapid breathing)?

From the Guidelines

To settle tachypnea, especially in palliative care, the focus should be on relieving symptoms and improving comfort, with interventions tailored to the patient's estimated life expectancy, as outlined in the palliative care guidelines 1. When managing tachypnea, it's crucial to assess symptom intensity and focus on comfort measures.

• For patients with an estimated life expectancy of years, interventions include assessing symptom intensity, using labored breathing or other physical signs of dyspnea in noncommunicative patients, and focusing on comfort by continuing to treat the underlying condition as appropriate, relieving symptoms with fans, oxygen if hypoxic and/or subjective relief is reported, and nonpharmacologic therapies, educational, psychosocial, and emotional support 1.
• For those with months to weeks of estimated life expectancy, if fluid overload is a contributing factor, decreasing or discontinuing enteral or parenteral fluid and considering low-dose diuretics can be beneficial. Additionally, opioids like morphine can be used for symptom relief, with doses adjusted based on the patient's opioid naivety or chronic use, alongside benzodiazepines for anxiety and medications to reduce excessive secretions 1.
• In the context of weeks to days, intensifying palliative care interventions and considering sedation for intractable symptoms are key, with a focus on providing emotional and spiritual support to the patient and their family 1. It's essential to address the underlying cause of tachypnea, whether it be fluid overload, opioid-responsive pain, or anxiety, and to tailor the management strategy to the patient's prognosis and preferences, ensuring that interventions prioritize comfort and quality of life above all, as supported by the most recent guidelines on palliative care 1.

From the FDA Drug Label

The usual dosage for adults and for children weighing at least 15 kg is 2.5 mg of albuterol (one vial) administered three to four times daily by nebulization. To administer 2.5 mg of albuterol, administer the entire contents of one sterile unit-dose vial (3 mL of 0. 083% inhalation solution) by nebulization. In controlled clinical trials, most patients exhibited an onset of improvement in pulmonary function within 5 minutes as determined by FEV1. Clinically significant improvement in pulmonary function (defined as maintenance of a 15% or more increase in FEV1 over baseline values) continued for 3 to 4 hours in most patients and in some patients continued up to 6 hours

To settle tachypnea, administer albuterol via nebulization as follows:

• Dosage: 2.5 mg of albuterol (one vial) three to four times daily
• Administration: Entire contents of one sterile unit-dose vial (3 mL of 0.083% inhalation solution) by nebulization over approximately 5 to 15 minutes
• Onset of action: Within 5 minutes as determined by FEV1
• Duration of action: Clinically significant improvement in pulmonary function continued for 3 to 4 hours in most patients and in some patients continued up to 6 hours 2 2

From the Research

Tachypnea Management

To settle tachypnea, several strategies can be employed, including:

• Administration of oxygen therapy, with a target oxygen saturation range of 94-98% for most hospitalized patients 3
• Use of bronchodilators, such as albuterol, to relax airway smooth muscle and improve breathing 4, 5
• Combination therapy with ipratropium and albuterol may be more effective than either agent alone in patients with chronic obstructive pulmonary disease (COPD) 5
• Basic airway management techniques, including bag mask ventilation and use of oropharyngeal and nasopharyngeal airways, may be necessary in severe cases 6

Considerations for Specific Patient Populations

• Patients with COPD may require specialized management, including the use of combination bronchodilator therapy and oxygen therapy 3, 5
• Patients with psychiatric problems, such as depression and anxiety, may require concurrent treatment with antidepressants and/or anxiolytics 7
• Elderly patients (75+ years) and female patients may be at higher risk for chronic use of antidepressants and/or anxiolytics 7

Oxygen Therapy

• Oxygen therapy can be administered via a variety of devices, including nasal cannulas, masks, and ventilators 3
• High-flow oxygen therapy may be beneficial in certain patient populations, such as those with severe respiratory distress 3
• Humidification of supplemental oxygen may be necessary when flows exceed 4 L/min 3