Breathing SPACE—a practical approach to the breathless patient

Abstract

Breathlessness is a common symptom that may have multiple causes in any one individual and causes that may change over time. Breathlessness campaigns encourage people to see their General Practitioner if they are unduly breathless. Members of the London Respiratory Network collaborated to develop a tool that would encourage a holistic approach to breathlessness, which was applicable both at the time of diagnosis and during ongoing management. This has led to the development of the aide memoire “Breathing SPACE”, which encompasses five key themes—smoking, pulmonary disease, anxiety/psychosocial factors, cardiac disease, and exercise/fitness. A particular concern was to ensure that high-value interventions (smoking cessation and exercise interventions) are prioritised across the life-course and throughout the course of disease management. The approach is relevant both to well people and in those with an underling diagnosis or diagnoses. The inclusion of anxiety draws attention to the importance of mental health issues. Parity of esteem requires the physical health problems of people with mental illness to be addressed. The SPACE mnemonic also addresses the problem of underdiagnosis of heart disease in people with lung disease and vice versa, as well as the systematic undertreatment of these conditions where they do co-occur.

Living with breathlessness: a systematic literature review and qualitative synthesis

“…Clinicians could use the breathing space concept to explore how the patient is coping and seeking help as well as previous experience of clinical attention to breathlessness. This approach is seen in the London Respiratory Network's Breathing SPACE framework [144] which encourages engaged coping strategies such as exercising, smoking cessation and seeking peer support and addresses mental health issues demonstrating responsiveness to symptoms in addition to disease processes.…”

Living well with breathlessness: how clinicians can help

“…tailored to match their patients' needs using the Breathing, Thinking, Functioning model 9 and the holistic approach to breathlessness developed by the London Respiratory Network. 10 By focusing on the symptom as a therapeutic target in its own right, clinicians can support patients to adopt more engaged coping approaches, more self-management techniques, and help 'move' them from 'life stops' to 'life changes':…”

Patterns of breathlessness and associated consulting behaviour: results of an online survey

“…The breathing SPACE (smoking, pulmonary disease, anxiety, cardiac disease, exercise level) framework has been proposed as a systematic way to approach conditions associated with breathlessness. 2 Breathlessness is often dismissed as a normal part of ageing, leading to late presentation and/or delayed diagnosis. 3 In clinical practice, respiratory and cardiovascular diseases account for approximately two-thirds of presentations with exertional breathlessness.…”