Intractable Breathlessness

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A number of lung diseases (e.g. chronic bronchitis and emphysema) are capable of producing shortness of breath that is often extremely distressing to the patient. Many of these conditions are irreversible, so it becomes necessary to target the symptom itself. The sensation of breathlessness is a complicated phenomenon that seems to depend upon central processing through respiratory and non-respiratory mechanisms (Guz 1996). Ideally, a treatment would relieve the unpleasant sensa tion without further compromising respiratory function. Opioids and benzodiazepines produce some relief but may have the dangerous side-effect of depressing respiration.

Patients have reported anecdotally that cannabis can relieve breathlessness by relieving anxiety and promoting relaxation. CB1 receptors are virtually absent from the part of the brain-stem which drives respiration (Herkenham et al. 1990), so it seems possible that symptom relief maybe achieved without negative effects upon breathing. THC has been shown to have anxiety-reducing and sedating effects (Fabre and McLendon 1981; Nicholson et al. 2004), as has CBD in larger doses (Zuardi et al. 1997). CBD is also thought to have useful modulating effects on some of the undesirable effects of THC (McPartland and Russo 2001).

At the time of writing, exploratory research of THC/CBD combinations in refractory breathlessness is getting underway, incorporating careful monitoring of respiratory function.

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