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Acceptability of the palliative dyspnoea protocol by emergency clinicians
  1. Thidathit Prachanukool1,2,
  2. Korawit Kanjana3,
  3. Rachel Somin Lee2,
  4. Mohammad Adrian Hasdianda2,
  5. Attakorn Raksasataya4,
  6. Kalpana N Shankar2,
  7. Maura Kennedy5,
  8. Shan Woo Liu5 and
  9. Kei Ouchi2
  1. 1Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  2. 2Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Center for Immunology and Inflammatory Diseases, Division of Rheumatology, Allergy and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  4. 4Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
  5. 5Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Thidathit Prachanukool, Department of Emergency Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; thidathit.pra{at}

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Dyspnea is the subjective experience of breathing discomfort and affects the quality of life in patients with serious, life-limiting illness.1 2 Dyspnoea is also one of the most distressing symptoms that necessitates visits to the emergency department (ED) in the last six months of life, and it is increasingly ranked the highest in the last two weeks of life.1 In addition to disease-oriented treatments, an adjunct opioid-based treatment for palliation of dyspnoea improves quality of life and functions significantly in patients with advanced respiratory illnesses.1 2 Despite the strong clinical evidence and many national organisations recommending the use of systemic opioids (grade 1B) as an adjunct therapy for relieving dyspnoea in patients with advanced terminal illnesses and refractory dyspnoea at the end of life,2 the utilisation by emergency clinicians is unknown. This study aims to determine the acceptability of this protocol by emergency clinicians and to gain information to improve the protocol implementation.


Due to the pressing need to relieve dyspnea with COVID-19, the palliative symptom management experts in our institution reviewed the current evidence and designed the protocol for acute dyspnoea in the ED, which provided the recommended prescription for all patients who experience any severity of dyspnoea (online supplemental file 1). This study took place in the ED of an academic medical centre. The participants included attending physicians, resident physicians and physician assistants, who provided initial care for patients with moderate to severe dyspnoea in the ED. This included …

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  • 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; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.