The most appropriate treatment of this patient's dyspnea is oral morphine. Dyspnea is common in many chronic progressive diseases near the end of life, and systemic opioids are the standard of care for refractory dyspnea in advanced disease. Although opioids have been shown to be very effective in treating dyspnea, the exact mechanisms underlying this benefit have not been well defined. Potential mechanisms of action that reduce dyspnea include altering central perception of dyspnea or modulating the activity of peripheral receptors in the lung that contribute to the sensation of dyspnea.

Many physicians worry about depressing respiratory drive with opioids in patients with end-stage disease and dyspnea. In fact, numerous studies have shown that opioids, when dosed and titrated appropriately, do not hasten death, do not raise PCO₂, and do not lead to respiratory failure, but do effectively manage the sensation of dyspnea. Accordingly, a consensus statement issued by the American College of Chest Physicians states that systemic opioids, dosed and titrated appropriately, are effective and safe for dyspnea in the setting of advanced disease. The dose is generally titrated to achieve the lowest effective dose needed to adequately treat a patient's dyspnea. This patient's emphysema is already being maximally medically managed without improvement of symptoms; therefore, she should receive oral morphine.

Nebulized lidocaine is sometimes used in suppressing intractable cough, but it has no role in treating dyspnea.

Nebulized morphine is often prescribed for relief of dyspnea. However, a meta-analysis showed that nebulized morphine had no benefit compared with nebulized saline in the treatment of dyspnea, and it should not supplant the use of systemic opioids to treat dyspnea.

Dyspnea often produces anxiety in patients, and benzodiazepines may have a role in the treatment of patients with both dyspnea and anxiety. Additionally, studies show that benzodiazepines can be helpful when added to opioids, but opioids remains first-line treatment for dyspnea. This patient does not have anxiety; therefore, lorazepam is not indicated.