9
In the ambulatory setting, patients may present with chronic dyspnea that may limit their
daily activities. A hierarchical approach is recommended to introduce interventions in a
step-wise manner to include treatment of reversible causes, a palliative care consultation,
non-pharmacologic measures, and pharmacologic measures. Opioids, if required, are mostly
available in oral route, although subcutaneous route is also possible. Regularly scheduled
opioids may be useful for everyday dyspnea and prophylactic opioids may be considered
prior to exertion. Although home versions of high flow nasal cannula and non-invasive
ventilation are not to be routinely provided, they may be appropriate for selected individuals
(light orange).
Non-invasive ventilation at home,
esp. if hypercapneic
Advanced Measures
High flow oxygen at home,
esp. if severely hypoxemic
