Managing Chronic Breathlessness
Relevant clinical background[edit | edit source]
Breathlessness is a complex sensation that affects the person experiencing it negatively as well it being unpleasant and oftentimes scary for those witnessing their loved one's situation.[1] Breathlessness or dyspnea is increasing hand in hand with an aging population and in chronic respiratory diseases where often multimorbidity is evident.[2]
Dyspnea results when there is a excess of stimulation in the pathways between the brain and the phrenic and intercostal nerves supplying the respiratory muscles. A mismatch of the sensory inputs and the motor output results in breathlessness. Descriptions of breathlessness include, airhunger, chest tightness and increased work to breathe.[3] Breathlessness can be described as how intense it it as well the how it's perceived and this can vary from person to person. Additionally, emotions, anxiety, and fear are often associated with this sensation and create a negative loop.
Outcome Measures[edit | edit source]
Medical Research Council Dyspnea (MRC) 1-5 Scale [1]A modified Medical Research Council (mMRC) 0-4 scale may be used in some clinical settings
Dyspnoea Management Questionnaire Dyspnoea
Modified Borg Scale
Management / Interventions[edit | edit source]
Management of dyspnea can include oral opioids, oxygen in individuals with resting hypoxemia. Non-pharmacologic options such as neuromuscular electrical muscle stimulation (NMES), use of a rollator, and chest wall vibration have been studied in the literature though evidence of these techniques vary [1] A team in Cambridge, England developed a model to help health care practitioners and individual better understand the complexities of dyspnea. The model developed is known as the Breathing, Thinking, Functioning model (BTF model)[4] See image below. Research done among health care practitioners state the model helps provide simple and practical ways of assisting individuals with strategies which enhance their understanding as well as provide self management tools. One such tool is the use of a fan which allows for cooling the face by affecting the facial nerves. This effect has been shown to relieve dyspnea and is both effective and cost effective.[5]
Individuals that experience an acute bout of dyspnea may benefit from being taught the SOS for SOB technique. This involves using various breathing techniques to allow for their breathing to become more manageable. It also includes reminding them that while breathlessness is uncomfortable it is not harmful. Further reminders about them being in control of their breathing helps and that it can de escalate the episode by actively trying to relax. A video describing how this plays out is included under resources.
In conclusion, there are a selection of non pharmacologic approaches available to manage dyspnea. Selection of the appropriate technique will depend on the individual and the how effective the intervention is. Using the BTF model shown below can help individuals feel more empowered by identifying which aspect of BTF is impacted most and finds ways to manage the dyspnea in small chunks decreasing the feeling of overwhelm.
The video below shows how to use a handheld fan to reduce breathlessness:
This video demonstrates how to manage an acute episode of breathlessness:
References[edit | edit source]
- ↑ 1.0 1.1 Marciniuk DD, Goodridge D, Hernandez P, Rocker G, Balter M, Bailey P, Ford G, Bourbeau J, O'Donnell DE, Maltais F, Mularski RA, Cave AJ, Mayers I, Kennedy V, Oliver TK, Brown C; Canadian Thoracic Society COPD Committee Dyspnea Expert Working Group. Managing dyspnea in patients with advanced chronic obstructive pulmonary disease: a Canadian Thoracic Society clinical practice guideline. Can Respir J. 2011 Mar-Apr;18(2):69-78.
- ↑ Currow DC, Dal Grande E, Ferreira D, Johnson MJ, McCaffrey N, Ekström M. Chronic breathlessness associated with poorer physical and mental health-related quality of life (SF-12) across all adult age groups. Thorax. 2017 Dec;72(12):1151-1153.
- ↑ Nishino T. Dyspnoea: underlying mechanisms and treatment. Br J Anaesth. 2011 Apr;106(4):463-74.
- ↑ Spathis A, Booth S, Moffat C, Hurst R, Ryan R, Chin C, Burkin J. The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease. NPJ Prim Care Respir Med. 2017 Apr 21;27(1):27.
- ↑ Huang SL, Lai WS, Fang SY. [Using Fans to Relieve Dyspnea: A Systematic Review and Clinical Implications]. Hu Li Za Zhi. 2018 Aug;65(4):84-93. Chinese.
- ↑ CUHNHS. Using a handheld fan to reduce breathlessness. Available from: https://www.youtube.com/watch?v=y5tBC5R8DYs [last accessed 20/01/2024]
- ↑ Hamilton Health Sciences. Managing an acute episode of shortness of breath. Available from: https://www.youtube.com/watch?v=KYj-T4Nd3h0 [last accessed 20/01/2024]
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