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Refractory dyspnea palliative management — ABIM Board MCQ

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ModerateGeneral Internal MedicineRefractory dyspnea palliative managementABIM Board

A 79-year-old woman with advanced COPD has severe dyspnea despite optimized inhaled therapy, pulmonary rehabilitation, and long-term oxygen. She is not hypercapnic and wants to remain alert enough to interact with family. Which of the following is the most appropriate management?

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Correct answer: C — Low-dose oral opioid titrated for refractory dyspnea with monitoring

Low-dose opioids can reduce refractory dyspnea in advanced cardiopulmonary disease when disease-directed treatment is optimized, with careful titration and monitoring. This is compatible with ongoing oxygen and goal-concordant care.

Reference: ATS Palliative Care in Pulmonary Disease Guidance; Palliative Care Society Guidance