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Dexamethasone (p69) could be helpful for assuaging breathlessness in some circumstances Refractory/severe breathlessness Refractory/extreme breathlessness in the dying affected person is distressing and scary for sufferers and their households After discussion with the patient and household, a syringe driver with opioid +/anxiolytic may be needed* the goal is to realize the required balance between sedative side effects and the management of breathlessness and anxiety; according to patient’s wishes * For specialist use or after specialist recommendation solely 27 Return to contents page Decisions about ventilation When a patient could also be susceptible to respiratory failure, the risks/benefits of mechanical air flow (invasive or non-invasive) ought to be thought-about and, where applicable, mentioned with the patient so as to keep away from disaster selections about ventilation It may be helpful at this stage to discuss stopping rules Careful documentation of the choice is critical For sufferers with progressive neuromuscular situations, early dialogue with the respiratory staff/specialist palliative care is advised* Sudden major airway obstruction in the palliative care setting it is a palliative care emergency. 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