Background: Delirium is a common distressing symptom observed in terminal patients with respiratory diseases and is treated with antipsychotic medication such as haloperidol. Its management is frequently difficult, especially in palliative home care, because of its limited administration method to oral or injections. Recently, a blonanserin transdermal patch was developed as the first antipsychotic percutaneous agent. After its available use, we recognized its potential for management of delirium and alleviation of uncontrolled dyspnea in clinical practice. Thus, this study aimed to assess its efficacy in terminal patients with respiratory diseases.

Methods: This retrospective study included 113 patients with respiratory diseases who were cared for in their homes. The efficacy was evaluated through the prevalence of terminal delirium before and after its treatment initiation for uncontrolled dyspnea.

Results: Blonanserin transdermal patch treatment for uncontrolled dyspnea improved the prevalence and severity of terminal delirium (from 70.4% to 16.3%, p<0.001) and reduced the number of doctor's visit to patients' houses within a week before their death (from 4.0 to 3.0, p=0.086). A sub-group analysis of 23 patients with interstitial pneumonia revealed that the treatment prevented dyspnea progression with inhibiting terminal delirium.

Conclusions: Blonanserin transdermal patch performed similarly to haloperidol, as previously reported, for managing terminal delirium. Our study suggests that a blonanserin transdermal patch potentially prevents terminal delirium and alleviated uncontrolled dyspnea in patients with respiratory diseases.