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Death from COVID-19: management of breathlessness: a retrospective multicentre study
  1. Colette Reid1,
  2. Barry Laird1,2,3,
  3. Susan Travers1,
  4. Jessica McNiff1,
  5. Suzanne Young1,
  6. Jack Maddicks1,
  7. Angela Bentley1 and
  8. Stephen Fenning1,4
  1. 1NHS Lothian Hospital Palliative Care Service, NHS Lothian, Edinburgh, UK
  2. 2Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
  3. 3St Columba's Hospice Care, Edinburgh, UK
  4. 4NHS Fife Specialist Palliative Care Service, NHS Fife, Kirkcaldy, UK
  1. Correspondence to Dr Stephen Fenning, NHS Fife Specialist Palliative Care Service, Victoria Hospice, Kirkcaldy, KY2 5AH, UK; stephen.fenning3{at}


Objectives Breathlessness is the most significant symptom in those dying of COVID-19. Historically, though, it has often been palliated poorly at end of life. The aim of this work was to assess whether breathlessness in patients dying from COVID-19 was being managed appropriately.

Methods A multicentre, retrospective analysis of clinical data was undertaken. Patients who had died of COVID-19 across three acute hospitals over a 2-month period were included. Those already prescribed background opioids and those who died in intensive care were excluded. Data were collected from clinical notes, where available.

Results 71 patients from 18 wards (3 hospitals) were included. The median total dose of opioid and midazolam given in the last 24 hours of life (continuous subcutaneous infusion ± ‘as required’ medication) was 33 mg (14–55) and 15 mg (6–26), respectively. 37 patients (52%) were prescribed continuous subcutaneous infusions. There were 426 recorded respiratory rates of at least 25 breaths per minute, for which an opioid or benzodiazepine was given in 113 (27%) of instances.

Conclusions Less than a third of episodes of breathlessness, as measured by respiratory rate, were palliated with anticipatory medicines. Specific palliative care guidelines for COVID-19 are necessary but may not always be followed.

  • dyspnoea
  • COVID-19
  • terminal care

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  • Contributors SF and CR conceived the idea. SF, CR, ST, JMc, SY, JMa and AB collected the data. BL undertook data cleaning and analyses. All authors contributed to the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.