American Board of Family Medicine (ABFM) Practice Exam

What is the first-line treatment for dyspnea in a terminally ill patient?

1. Acetaminophen

2. Inhaled bronchodilator

3. Morphine

4. Antibiotics

The correct answer is: Morphine

In managing dyspnea in terminally ill patients, morphine is recognized as the first-line treatment option. The reason for this preference is that morphine possesses both analgesic and sedative properties, which can significantly alleviate the sensation of breathlessness. It reduces the work of breathing and the perception of dyspnea by acting on the central nervous system; it decreases anxiety associated with breathlessness and promotes a sense of relaxation. While inhaled bronchodilators may be useful in certain cases of obstructive pulmonary disease, their efficacy is primarily related to conditions such as asthma or COPD rather than addressing dyspnea in a terminally ill patient. Acetaminophen is primarily a pain reliever and does not have any direct effect on dyspnea. Antibiotics can be relevant if a respiratory infection is the cause of dyspnea, but in the context of terminal illness, interventions to address the underlying cause may not be appropriate or effective. Therefore, morphine is preferred for symptom management in this setting.