American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the standard care for refractory dyspnea in advanced disease at the end of life?

1. Inhaled corticosteroids

2. Systemic opioids

3. Oxygen therapy only

4. Palliative care consultations

The correct answer is: Systemic opioids

The standard care for refractory dyspnea in advanced disease at the end of life is the use of systemic opioids. In patients facing advanced stages of illness, dyspnea can be distressing, and systemic opioids have been shown to be effective in reducing the sensation of breathlessness, improving comfort, and enhancing the quality of life. Opioids work through a variety of mechanisms, including their action on the central nervous system to depress respiratory drive, and they can also reduce anxiety associated with dyspnea. Fentanyl, morphine, and other opioids can be used depending on individual patient factors, and they can be titrated to effectively manage symptoms while also considering potential side effects. While inhaled corticosteroids are typically used for managing certain respiratory conditions, they are not generally effective in treating dyspnea in the context of advanced illness. Oxygen therapy can benefit patients with certain types of respiratory failure but may not alleviate perceptual dyspnea effectively in all patients, especially when oxygen saturation levels are adequate. Palliative care consultations are essential for comprehensive management of patients nearing the end of life, but they are not a direct treatment for refractory dyspnea. Instead, they offer additional support and guidance on symptom management and overall care strategy.