Cannabis-Induced Gastrointestinal Tract Symptoms in the Adult Population: A Systematic Review.

OBJECTIVE: Cannabinoid usage is widespread in the self-management of various medical ailments. However, adverse effects have been reported with use, especially pertaining to the gastrointestinal system in adults and aged patients. These range from nausea, vomiting, bloating, or abdominal pain. This systematic review of previously reported cannabis-induced gastrointestinal symptoms in the adult population from the literature provides an analysis of relevant data to enhance knowledge and awareness of this topic. METHODS: PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar databases were searched for relevant studies published from inception to March 2023. RESULTS: The search yielded 598 results, of which 13 were deemed relevant and underwent further review. These included two systematic reviews, one retrospective cohort study, one retrospective chart review, two cross-sectional studies, one survey, and six case reports. The Cochrane Risk Tool for bias analysis was applied where relevant. The total number of people in the studies selected for analysis was 79, 779. Twelve out of the thirteen included studies reported some type of gastrointestinal tract symptoms experienced in medical and/or recreational cannabis users ranging from nausea, vomiting, diarrhoea, abdominal pain to adult intussusception. CONCLUSION: Potential limitations include small sample sizes, variation in research methodologies, varied studied designs, and limited availability of data on specific populations such as geriatric users. Further research is warranted to add to current evidence pertaining to this emerging topic of significance, fill the broad knowledge gaps and contribute to evidence-based guidelines for healthcare professionals, ensuring safe prescribing practices and provision of quality care.

The Role of Intermittent Fasting and Dieting on Cognition in Adult Population: A Systematic Review of the Randomized Controlled Trials.

OBJECTIVE: A healthy diet is a modifiable risk factor that may impact cognition. A unique type of diet may include intermittent fasting (IF), an eating pattern in which individuals go extended periods with little or no meal intake, intervening with periods of normal food intake. IF has multiple health benefits including maintenance of blood glucose levels, reduction of insulin levels, depletion or reduction of glycogen stores, mobilization of fatty acids, and generation of ketones. IF has shown neuroprotective effects as it may lead to increased neurogenesis in the hippocampus, which may contribute to cognitive resilience. Diets including IF were examined as lifestyle modifications in the prevention and management of cognitive decline. METHODS: A systematic literature search was conducted for randomized controlled trials (RCTs) which assessed the effect of dieting on cognitive functions in adults. RESULTS: Dietary Approaches to Stop Hypertension (DASH), low-glycemic diets, and caloric restriction have shown improvement in cognitive function; however, there was a negative impact on problem-solving in those with comorbid cardiovascular disease. There is also contradictory evidence that caloric restriction and diet alone may not be sufficient for the improvement of cognitive functions and that exercise may have better efficacy on cognition. CONCLUSION: IF is considered a safe intervention, and no adverse effects were found in the reviewed studies; however, evidence is limited as there were only 9 low-quality RCTs that assessed the impact of IF on cognition. DASH, low-glycemic diets, and exercise may have effective roles in the management and prevention of cognitive decline, although further research is needed.

Therapeutic Touch in the Management of Responsive Behaviors in Patients with Dementia.

INTRODUCTION: This study aimed to investigate the use of therapeutic touch (TT) in the management of responsive behaviors in patients with dementia. METHODS: A randomized, double-blinded control trial was used to compare response to TT in a population with responsive behaviors in dementia, in 3 phases, pretreatment, treatment, and posttreatment each lasting 5 days. The participants were divided into three groups: experimental, placebo, and control. The experimental group received regular TT, the placebo group received mimic TT, and the control group received regular routine care. Behavior was observed and recorded by trained research assistants every 20 min during the study time throughout each of the phases. Modified Agitated Behavior Rating Scale (ABRS) and Revised Memory and Behavior Check (RMBC) scores were used to assess the behavioral symptoms of dementia throughout the study. RESULTS: All groups had decreasing RMBC scores during the pretreatment period, however; the experimental TT group was the only group whose RMBC scores continued to decrease during the treatment period. All groups had a similar pattern of rates of change in ABRS scores over the 15-day period, with no differential pattern of results related to experimental TT. CONCLUSION: Despite limited evidence, TT should be explored as an adjunctive therapy for reducing behavioral symptoms in individuals with dementia. Further research is needed to determine the effects of TT on responsive behaviors in dementia. There is a need for studies with larger sample sizes, equal distribution of participants between groups (in terms of dementia stages), and longer post study follow-ups.

COVID-19 Virtual Care for the Geriatric Population: Exploring Two Sides of the Coin.

Virtual care (VC) continues to gain attention as we make changes to the way we deliver care amidst our current COVID-19 pandemic. Exploring various ways of delivering care is of importance as we try our best to ensure we prioritize the health and safety of every one of our patients. One mode of care that is continuing to garner attention is telemedicine - the use of virtual technology to deliver care to our patients. The geriatric population has been of particular focus during this time. As with any new intervention, it is important that both the benefits and challenges are explored to ensure that we are finding ways to accommodate the patients we serve while ensuring that they receive the care that they require. This study aims to explore the various benefits and challenges to implementing VC in our day-to-day care for the geriatric population.

The Effectiveness of Cannabis and Cannabis Derivatives in Treating Lower Back Pain in the Aged Population: A Systematic Review.

BACKGROUND/AIMS: Cannabis is increasingly used in the management of pain, though minimal research exists to support its use since approval. Reduction in stigma has led to a growing interest in pharmaceutical cannabinoids as a possible treatment for lower back pain (LBP). The objective of this review was to assess the role and efficacy of cannabis and its derivatives in the management of LBP and compile global data related to the role of cannabis in the management of LBP in an aging population. METHODS: A systematic review was conducted using predetermined keywords by 3 independent researchers. Predetermined inclusion and exclusion criteria were applied, and 23 articles were selected for further analysis. RESULTS: Studies identified both significant and insignificant impacts of cannabis on LBP. Contradicting evidence was noted on the role of cannabis in the management of anxiety and insomnia, 2 common comorbidities with LBP. The existing literature suggests that cannabis may be used in the management of LBP and comorbid symptoms. CONCLUSIONS: Further research is needed to consider cannabis as an independent management option. There is a lack of evidence pertaining to the benefits of cannabis in an aged population, and thus, additional research is warranted to support its use in the aged population.

A Systematic Review on Cannabis Hyperemesis Syndrome and Its Management Options.

INTRODUCTION: Several forms of cannabinoids are currently being used to manage nausea and vomiting (N/V). Emerging cases of refractory N/V associated with chronic cannabis use among adults and older patients have been reported named cannabis hyperemesis syndrome (CHS). CHS is a condition that leads to repeated and severe N/V in long-term users of cannabinoids. OBJECTIVE: The aim of this study was to outline current treatments for the management of CHS. METHODS: A systematic review was conducted using PubMed, Ovid MEDLINE, Cochrane Central, EMBASE, and Google Scholar. Databases were used to search for articles on CHS published from January 2009 to June 2021, yielding 225 results of which 17 were deemed relevant and underwent review by 2 separate reviewers. RESULTS: The duration of cannabis administration ranged between 6 months to 11 years may precipitate symptoms of CHS. The Rome IV diagnostic criteria of CHS require cannabinoid use and persistence of N/V symptoms for at least the past 6 months. Cannabis cessation is noted to be the most successful management, but other treatments also demonstrated symptom relief; these include hot water hydrotherapy, topical capsaicin cream, haloperidol, droperidol, benzodiazepines, propranolol, and aprepitant administration. CONCLUSION: More research on CHS is needed to enhance knowledge translation, education, and create awareness in the medical community on the side effects of cannabinoids and to propose the best treatment options.

Managing Fall Prevention through Exercise in Older Adults Afflicted by Cognitive and Strength Impairment.

INTRODUCTION: A growing trend in medicine is older adults and increased need for geriatric services. Falls contribute heavily to hospitalizations and worsening of overall health in this frail demographic. There are numerous biological and physical culprits which, if targeted, can prevent falls. The objective was to review benefits of different types of exercises for fall prevention for older persons who are community-dwelling or living in long-term care facilities. METHODS: A systematic review was conducted to determine the different types of exercises for fall prevention. Data extraction via a standardized protocol was performed to assess study design, outcomes, limitations, and author's conclusions. Corroborative themes were identified and the authors responsible for the contributing research were cited as they came up. Nineteen randomized controlled trials were identified, between 1990 and 2018, using MEDLINE, PubMed, Cochrane, CINAHL, and Web of Science databases. Studies involving adults greater than age 60 in high-risk community or nursing home populations in the English language with a duration longer than or equal to 6 weeks with focuses on either low-risk balance, strength, or combination of both and whole-body vibration. RESULTS: Balance exercise training increased balance at 6 and 12-month intervals involving balance, strength, and cognitive training. DISCUSSION: Insignificant results were seen in whole-body vibration and differing results existed for Tai Chi. It is important to recognize that although exercises help reduce the risk of falling and play a significant role in improving mobility safely, there will always be a risk of falls.

Benzodiazepine Use and Morbidity-Mortality Outcomes in a Geriatric Palliative Care Unit: A Retrospective Review.

INTRODUCTION: Patients often experience delirium at the end of life. Benzodiazepine use may be associated with an increased risk of developing delirium. Alternate medications used in conjunction with benzodiazepines may serve as an independent precipitant of delirium. The aim is to understand the role of benzodiazepines in precipitating delirium and advanced mortality in palliative care population at the end of life. METHODS: A retrospective medical chart review was conducted at a hospice and palliative care inpatient unit between the periods of June 2017-December 2017 and October 2017-November 2018. It included patients in hospice and palliative care inpatient units who received a benzodiazepine and those who did not. Patient characteristics, as well as Palliative Performance Scale score, diagnosis, and occurrence of admission, terminal, and/or recurrent delirium, were collected and analyzed. RESULTS: Use of a benzodiazepine was not significantly associated with overall mortality nor cause-specific death without terminal delirium rate. However, it was significantly associated with higher cause-specific death with terminal delirium rate and a higher recurrent delirium rate. DISCUSSION: This retrospective chart review suggests an association between benzodiazepine use and specific states of delirium and cause-specific death. However, it does not provide strong evidence on the use of this drug, especially at the end of life, as it pertains to the overall mortality rate. Suggested is a contextual approach to the use of benzodiazepines and the need to consider Palliative Performance Scale score and goals of care in the administration of this drug at varying periods during patient length of stay.

A systematic review of the integration of palliative care in dementia management.

OBJECTIVE: Dementia is a progressive illness with a complex biopsychosocial constellation of symptoms faced by millions of individuals and families worldwide. Palliative care teams have specialized in symptom management and end-of-life care for decades; however, the role of palliative care in dementia management is not yet well elucidated. The aim of this systematic review was to understand the impact of palliative care in dementia management. METHOD: This systematic review was conducted using a prospective study protocol. Medline and PubMed were searched from January 1, 1998 to October 2017. Eligible studies included single-blind cluster, two-arm parallel cluster, or unblinded randomized controlled trials (RCTs), observational studies, retrospective cohort studies, cross-sectional studies, concurrent mixed methods study, qualitative study, and Delphi studies. RESULTS: Four key themes were identified in this review: goals of care and end-of-life conversations, symptom management, emergency room visits, and prescribing behavior. In each domain, palliative care consultation either showed benefit or was postulated to have benefit if implemented. SIGNIFICANCE OF RESULTS: Although the literature to support or refute thematic conclusions is not large, there was a trend toward patient care benefit across several domains. Large RCTs with longer follow-up across different settings should be undertaken to solidify the themes and trends outlined in this review. Understanding the views of healthcare providers including referral sources (i.e., general practitioners and specialists) through qualitative research could optimize palliative care referrals, implement palliative care recommendations, and improve a targeted palliative care education curriculum.

Knowledge translation: An interprofessional approach to integrating a pain consult team within an acute care unit.

Management of pain in the frail elderly presents many challenges in both assessment and treatment, due to the presence of multiple co-morbidities, polypharmacy, and cognitive impairment. At Baycrest Health Sciences, a geriatric care centre, pain in its acute care unit had been managed through consultations with the pain team on a case-by-case basis. In an intervention informed by knowledge translation (KT), the pain specialists integrated within the social network of the acute care team for 6 months to disseminate their expertise. A survey was administered to staff on the unit before and after the intervention of the pain team to understand staff perceptions of pain management. Pre- and post-comparisons of the survey responses were analysed by using t-tests. This study provided some evidence for the success of this interprofessional education initiative through changes in staff confidence with respect to pain management. It also showed that embedding the pain team into the acute care team supported the KT process as an effective method of interprofessional team building. Incorporating the pain team into the acute care unit to provide training and ongoing decision support was a feasible strategy for KT and could be replicated in other clinical settings.

A Case Report on Cannabinoid Hyperemesis Syndrome in Palliative Care: How Good Intentions Can Go Wrong.

INTRODUCTION: Synthetic cannabinoids are commonly used to manage pain, nausea, and vomiting in oncology and palliative care. Despite the current acceptance of cannabinoids as a treatment option for nausea and vomiting, there is a lack of data regarding the side effects of its prolonged use leading to possible toxicity due to accumulation, and as a result, exacerbation of nausea and vomiting rather than alleviation. Case Report Presentation: The patient, a 70-year-old female, was residing in the palliative care unit with the diagnosis of small-cell lung cancer. She underwent a course of chemotherapy consisting of paclitaxel, docetaxel, and cisplatin. She presented with hair loss, sore mouth, a loss of appetite, diarrhea, neuralgia, nausea, and vomiting which developed approximately 5 h after chemotherapy. Nabilone was used for the last 5 years to manage the patient's neuralgia. As her cancer progressed, a dosage of nabilone was incrementally increased from 0.5 to 2 mg to control her pain; however, it exacerbated refractory nausea and vomiting. Nabilone was discontinued 7 weeks after administration due to suspicion of cannabinoid hyperemesis syndrome. Hot baths were attempted with temporary relief. Her pain became well controlled with opioids and adjuvants and there has been no recurrence of nausea and vomiting since the cessation of nabilone. DISCUSSION/CONCLUSION: Successful recognition and management of cannabinoid hyperemesis syndrome is especially important in individuals with comorbid disorders in order to avoid cannabis toxicity.

Efficacy of COVID-19 treatments among geriatric patients: a systematic review.

Introduction: A majority of the fatalities due to COVID-19 have been observed in those over the age of 60. There is no approved and universally accepted treatment for geriatric patients. The aim of this review is to assess the current literature on efficacy of COVID-19 treatments in geriatric populations. Methods: A systematic review search was conducted in PubMed, MedRxiv, and JAMA databases with the keywords COVID-19, geriatric, hydroxychloroquine, dexamethasone, budesonide, remdesivir, favipiravir, ritonavir, molnupiravir, tocilizumab, bamlanivimab, baricitinib, sotrovimab, fluvoxamine, convalescent plasma, prone position, or anticoagulation. Articles published from January 2019 to January 2022 with a population greater than or equal to 60 years of age were included. Interventions examined included hydroxychloroquine, remdesivir, favipiravir, dexamethasone, budesonide, tocilizumab, bamlanivimab, baricitinib, sotrovimab, convalescent plasma, prone position, and anticoagulation therapy. Outcome measures included viral load, viral markers, ventilator-free days, or clinical improvement. Results: The search revealed 302 articles, 52 met inclusion criteria. Hydroxychloroquine, dexamethasone, and remdesivir revealed greater side effects or inefficiency in geriatric patients with COVID-19. Favipiravir, bamlanivimab, baricitinib, and supportive therapy showed a decrease in viral load and improvement of clinical symptoms. There is conflicting evidence with tocilizumab, convalescent plasma, and anticoagulant therapy in reducing mortality, ventilator-free days, and clinical improvements. In addition, there was limited evidence and lack of data due to ongoing trials for treatments with sotrovimab and budesonide. Conclusion: No agent is known to be effective for preventing COVID-19 after exposure to the virus. Further research is needed to ensure safety and efficacy of each of the reviewed interventions for older adults.

Evading Seizures: Phenobarbital Reintroduced as a Multifunctional Approach to End-of-Life Care.

The selected case study aimed to evaluate the role of phenobarbital as a drug of choice in end-of-life (EOL) settings. Phenobarbital is efficacious in management of EOL seizures and agitation, can be easily administered via different modes, and utilized in various palliative care (PC) settings. Mrs. X., 90-year-old female with a history of glioblastoma multiforme, was a resident of long-term care, residing in a PC unit. She presented with illness progression which resulted in an increased frequency of generalized tonic-clonic seizures which were managed initially with phenytoin. Due to the advanced stage of the illness and significant decline in the patient's cognitive and physical status, oral route and intravenous access were lost, and phenytoin became not an option for seizure control. She was then rotated to subcutaneous phenobarbital, as a result, starting at 30 mg once a day. The dose needed to be titrated up in 15 mg increments to achieve adequate seizure control, and she stabilized on 60 mg of subcutaneous phenobarbital after 2 days. No serious adverse skin reactions were noted with the use of phenobarbital, and it did not abruptly end a patient's life when used at appropriate doses. The sedative properties of phenobarbital had benefited Mrs. X and allowed her to be comfortable approaching EOL with glioblastoma multiforme.

Methadone in Pain Management: A Systematic Review.

Adequate analgesia can be challenging, as pharmacological options are not necessarily effective for all types of pain and are associated with adverse effects. Methadone is increasingly being considered in the management of both cancer-related and noncancer-related pain. The purpose of this article is to provide a narrative review of all available randomized controlled trials (RCTs) investigating the effectiveness of methadone in the management of pain, in relation to a comparison drug. The primary outcome was analgesic effectiveness, and the secondary outcomes were side effects and cost. A search of PubMed, Medline, Embase, and Google Scholar databases was conducted to identify eligible RCTs and methodologic quality was assessed. A total of 40 RCTs were included in this review. The majority compared methadone to morphine or fentanyl. Analgesic effectiveness of methadone was demonstrated in different types of pain, including postprocedural, cancer-related, nociceptive, and neuropathic pain. The evidence demonstrates that the use of methadone in postprocedural pain and in cancer-related pain may be dependent on the procedure and cancer type, respectively. Side effects experienced were generally similar to the comparison drug, and lower cost was a benefit to using methadone. Methadone may also be useful as an adjunctive analgesic for adequate pain control, as well as in patients with renal impairment. Additional high-quality, large-scale RCT evidence is needed to establish its role as monotherapy or as an adjunctive medication. Future research should also aim to standardize reported outcomes for measuring analgesic effectiveness to permit for pooled analysis across studies. PERSPECTIVE: This article presents a systematic review, which includes a summary of published RCTs investigating the effectiveness of methadone in the management of pain. This is important for determining its analgesic utility and for identifying gaps in existing knowledge.

Is There a Role for Bismuth in Diarrhea Management?

Diarrhea, an illness of both the developed and developing world, involves the burdensome characteristics of frequent bowel movements, loose stools, and abdominal discomfort. Diarrhea is a long-standing challenge in palliative care and can have a myriad of causes, making symptomatic treatment pertinent when illness evaluation is ongoing, when there is no definitive treatment approach, or when effective treatment cannot be attained. Symptomatic therapy is a common approach in palliative care settings. Bismuth is a suitable agent for symptomatic therapy and can be effectively employed for management of chronic diarrhea. The objective of this narrative review is to examine the role of bismuth in management of diarrheal symptoms. To explore this, PubMed (including Medline) and Embase were used to search the existing literature on bismuth and diarrhea published from 1980 to 2019. It was found that bismuth has potential utility for diarrheal relief in multiple settings, including microscopic colitis, traveler's diarrhea, gastrointestinal infection, cancer, and chemotherapy. It also has great potential for use in palliative care patients, due to its minimal side effects. Overall, the antisecretory, anti-inflammatory, and antibacterial properties of bismuth make it a suitable therapy for symptomatic treatment of diarrhea. The limited range of adverse side effects makes it an appealing option for patients with numerous comorbidities. Healthcare providers can explore bismuth as an adjunct therapy for diarrhea management in an array of conditions, especially in the palliative care setting.

Integration of palliative care in Parkinson's disease management.

BACKGROUND: Parkinson's disease is a progressive neurodegenerative disorder that negatively impacts the lives of affected people. The therapeutic benefits of treatment only decrease going forward from the time of diagnosis. Motor and non-motor symptoms alike create a heavy burden for patients and those involved in their care. Palliative care is utilized for patients with serious illnesses and when integrated into patients with Parkinson's disease, improves quality of life by addressing symptoms of discomfort, which ultimately reduces symptom burden to patients and alleviates caregiver stress. OBJECTIVE: This review aims to assess the efficacy of palliative care in the management of Parkinson's disease by exploring the benefits of palliative care integration throughout multiple relevant themes to demonstrate the optimal care delivery. METHODS: Comprehensive searches on the role of palliative care in Parkinson's disease patients within MEDLINE, PUBMED, CINAHL, CENTRAL, PsycINFO, Embase, and BioMed Central, considering publications between March 2010 - February 2020 were performed. A grey literature search was also performed for additional information. RESULTS: Analysis of various existing literature has demonstrated promise in timely palliative care integration for patients with Parkinson's disease, which has shown improvement in the quality of life of Parkinson's disease patients. It also strives to alleviate caregivers' stress and improve their quality of life, although insufficient research exists to support this. Palliative care in Parkinson's disease is a growing area of interest, evidently demonstrating the potential to expand among the current approaches. CONCLUSION: Understanding the connections between the themes surrounding palliative care is crucial for successful integration in Parkinson's disease management. It is determined that integration of palliative care in patients with Parkinson's disease help to not only improve patients' experiences but also their caregiver's experiences throughout the disease trajectory. Further research should be conducted to address how palliative care will focus on alleviating caregiver burden and establish specific prognostication tools for Parkinson's disease patients.

Palliative Care: Too Good to Be True?

INTRODUCTION: Many patients and their families are hesitant to consult a palliative care (PC) team. In 2014, approximately 6,000,000 people in the United States could benefit from PC, and this number is expected to increase over the next 25 years. OBJECTIVES: The purpose of this review is to shed light on the significance of PC and provide a holistic view outlining both the benefits and existing barriers. METHODS: A literature search was conducted using MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, and Web of Science to identify articles published in journals from 1948 to 2019. A narrative approach was used to search the grey literature. DISCUSSION: Traditionally, the philosophy behind PC was based on alleviating suffering associated with terminal illnesses; PC was recommended only after other treatment options had been exhausted. However, the tenets of PC are applicable to anyone with a life-threatening illness as it is beneficial in conjunction with traditional treatments. It is now recognized that PC services are valuable when initiated alongside disease-modifying therapy early in the disease course. Studies have shown that PC decreased total symptom burden, reduced hospitalizations, and enabled patients to remain safely at home. CONCLUSION: As the population ages and chronic illnesses become more widespread, there continues to be a growing need for PC programs. The importance of PC should not be overlooked despite existing barriers such as the lack of professional training and the cost of implementation. Education and open discussion play essential roles in the successful early integration of PC.

Do Exercises Prevent Falls Among Older Adults: Where Are We Now? A Systematic Review.

OBJECTIVE: To determine whether single interventions (SI), multifactorial interventions (MI), or multiple component interventions (MCI) including vitamin D supplementation prevent the incidence of falls and fall risk factors among older adults who are community-dwelling or living in long-term care facilities. DESIGN: Systematic review. METHODS: PubMed, Scopus, MEDLINE, and Cochrane were searched with restrictions applied to publication year (2015‒2019) and language (limited to studies published in English). After duplicate removal and title and abstract screening, 2 authors independently identified eligible studies on the basis of inclusion criteria. Risk of bias and quality of evidence were assessed. RESULTS: Thirty-four studies were included after screening titles and abstracts from 855 citations and 129 full-text articles. Thirteen randomized-controlled trials and clinical trials (5 on MI, 1 on MCI, and 7 on SI) including 2232 participants and 21 systematic reviews (assessing SI, MI, MCI, or all) were extracted for qualitative synthesis. Fifteen out of 20 studies that reported outcomes on falls rate found a significant reduction. Seventeen out of 23 studies with outcomes on fall risk factors concluded a significant improvement. Five studies found no significant differences in falls incidence, and 5 studies found no significant differences in fall risks. One study reported worsened outcomes, including poorer balance. CONCLUSION AND IMPLICATIONS: Although results are inconclusive, SI, MI, and MCI involving exercises may prevent falls. Vitamin D supplementation may be beneficial alongside exercise; however, whether vitamin D use consistently reduces falls incidence or fall risks remains uncertain. Exercises that are individually tailored to participants' capabilities and risks may be the most effective falls prevention interventions. Implementation may reduce medical costs and improve quality of life for older adults who are community-dwelling or are living in long-term care facilities.

Management of Breathlessness in Palliative Care: Inhalers and Dyspnea-A Literature Review.

INTRODUCTION: Dyspnea is prominently observed in palliative care (PC). Dyspnea can be multifactorial, primarily caused by obstructive or restrictive lung diseases or secondarily induced by various comorbidities. Numerous interventions exist, with route of administration and efficacy requiring further discussion. Despite opioids being the first line of treatment, their adverse effects lead to reluctance on the side of patients to take them, creating limitations in patient management planning. OBJECTIVES: This paper reviews and highlights the role of inhalers for dyspnea management in PC. METHODS: The CINAHL, CENTRAL, and OVID databases were searched for scholarly articles on the role of inhalers in dyspnea management from 1998 to the present. A grey literature Internet search was also performed via Google, the World Health Organization, and CareSearch. Twenty-five articles relevant to the subject at hand were located and summarized. The Cochrane Systematic Reviews of Health Promotion and Public Health Interventions Handbook was consulted for structuring. RESULT: Isolated bronchodilators can be effective in dyspnea management. However, combination with opioids leads to a 52% reduction of dyspnea, demonstrating efficacy of their combined use. There is a role for conventional inhalers not only in patients afflicted with chronic obstructive pulmonary disease, but also in those where obstruction is reversible, and in cases of dyspnea not yet diagnosed. CONCLUSION: Inhalers can be utilized as adjuvant therapy to opioids, to limit opioid use, augment responses to dyspnea, and/or minimize opioid side effects, especially in opioid-naïve patients. Correct administration can increase the efficacy of short-acting beta-agonists, long-acting beta-agonists, short- and long-acting anticholinergic agents, and inhaled corticosteroids, achieving reduction and alleviation of dyspnea.