Treating "Air Hunger"

[newbiepnp, MSN, RN, NP, CNS]

I was recently asked about the treatment of "air hunger" on a pre-employment exam. I have never heard of this term before.

My choices are:

1) increase O2 to 10LPM

2) elevate HOB to 90 degrees

3) assist patient to do "purse-lipped' breathing

4) administer IPPB as ordered

Which action is NOT appropriate?

[Corey Narry, MSN, RN, NP]

That's a tough one. The word "air hunger" is used to denote the patient's subjective experience of dyspnea or shortness of breath. As a rule, the approach to treating dyspnea is to address its underlying cause (i.e., more oxygen if due to hypoxia, diurese if due to pulmonary edema, bronchodilators if due to bronchospasm, lung expansion strategies if due to atelectasis). The choices given are all approaches used in a patient who presents with dyspnea from a known etiology. However, I am inclined to answer #4 (administer IPPB as ordered) because IPPB is not the first line of treatment in dyspnea due to atelectasis. IPPB was popularly used in the 60's and 70's for atelectasis but lost favor to other effective and more benign modalities such as incentive spirometry. Other newer devices also use the same concept as IPPB but are better tolerated such as EZPAP and Acapella devices.

[KateRN1]

Air hunger is typically experienced by end-stage COPD patients who are CO2 retainers. Increasing oxygen delivery rate would likely knock out the impetus to breathe. Although IPPB isn't first line treatment, it's still not as bad as increasing the O2. That's my two cents' worth.