Current pharmacological strategies for symptomatic reduction of persistent breathlessness – a literature review

Kochovska, Slavica; McNeill, Richard; Currow, David

doi:10.1080/14656566.2022.2160239

Cited by 3 publications

(2 citation statements)

References 117 publications

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“…The invisibility of breathlessness 48 contributes to the symptom being undertreated despite the availability of a range of evidence-based non-pharmacological and pharmacological therapies. 49 50 Given the multidimensional nature and extent of disability experienced, improving the recognition of long-term breathlessness (including its presence and, if present, its severity and impact) in routine consultations and optimising its assessment and management are critical first steps.…”

Section: Discussionmentioning

confidence: 99%

Disability and long-term breathlessness: a cross-sectional, population study

Kochovska,

Ferreira,

Chang

et al. 2024

BMJ Open Resp Res

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IntroductionDisability, resulting from altered interactions between individuals and their environment, is a worldwide issue causing inequities and suffering. Many diseases associated with breathlessness cause disability but the relationship between disability and the severity of breathlessness itself is unknown.This study evaluated associations between disability using the WHO’s Disability Assessment Schedule (WHODAS) 2.0 and levels of long-termbreathlessness limiting exertion.MethodsThis population-based, cross-sectional online survey (n=10 033) reflected the most recent national census (2016) by age, sex, state/territory of residence and rurality. Assessments included self-reported disability (WHODAS 2.0 12-item (range 12 (no disability) to 60 (most severe disability)) assessed in 6 domains) and long-termbreathlessness limiting exertion(modified Medical Research Council (mMRC) breathlessness scale; 0–4 (4—most severe)). Days in the last month affected by breathlessness were reported.ResultsOf respondents (52% women; mean age 45), mean total disability score was 20.9 (SD 9.5). 42% (n=4245) had mMRC >0 (mMRC1 31% (n=3139); mMRC2 8% (n=806); mMRC3,4 3% (n=300)). Every level of long-termbreathlessness limiting exertionwas associated with greater levels of disability (total p <0.001; each domain p <0.001). The most compromised domains wereMobilityandParticipation.In the last 30 days, people with severe breathlessness (mMRC 3–4): experienced disability (20 days); reduced activities/work (10 days); and completely forwent activities (another 5 days).ConclusionsDisability should be in the definition of persistent breathlessness as it is systematically associated with long-termbreathlessness limiting exertionin a grade-dependent, multidimensional manner. Disability should be assessed in people with long-term breathlessness to optimise their social well-being and health.

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Section: Discussionmentioning

confidence: 99%

Disability and long-term breathlessness: a cross-sectional, population study

Kochovska,

Ferreira,

Chang

et al. 2024

BMJ Open Resp Res

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“…People who experience symptom clusters associated with chronic breathlessness often have a greater need for healthcare interventions, experience greater symptom-related morbidity and are at a heightened risk of mortality ( Currow et al, 2021 ; Molassiotis et al, 2021 ; Park & Larson, 2014 ). The management of chronic breathlessness requires the treatment of underlying conditions to be optimized, the use of non-pharmacological interventions to support self-management of breathlessness, and subsequently, the introduction of pharmacological measures, including opioids if required ( Ferreira et al, 2022 ). Despite the evidence supporting the use of non-pharmacological interventions to manage chronic breathlessness, breathlessness continues to be inadequately managed for most people ( Booth et al, 2015 ; Hutchinson et al, 2018 ; Schunk et al, 2018 ).…”

Section: Introductionmentioning

confidence: 99%

A Mixed Methods Evaluation of a Pilot Multidisciplinary Breathlessness Support Service

et al. 2023

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Breathlessness support services have demonstrated benefits for breathlessness mastery, quality of life and psychosocial outcomes for people living with breathlessness. However, these services have predominantly been implemented in hospital and home care contexts. This study aims to evaluate the adaptation and implementation of a hospice-based outpatient Multidisciplinary Breathlessness Support Service (MBSS) in Ireland. A sequential explanatory mixed methods design guided this study. People with chronic breathlessness participated in longitudinal questionnaires ( n = 10), medical record audit ( n = 14) and a post-discharge interview ( n = 8). Caregivers ( n = 1) and healthcare professionals involved in referral to ( n = 2) and delivery of ( n = 3) the MBSS participated in a cross-sectional interview. Quantitative and qualitative data were integrated deductively via the pillar integration process, guided by the RE-AIM framework. Integration of mixed methods data enhanced understanding of factors influencing the reach, adoption, implementation and maintenance of the MBSS, and the potential outcomes that were most meaningful for service users. Potential threats to the sustainability of the MBSS related to potential preconceptions of hospice care, the lack of standardized discharge pathways from the service and access to primary care services to sustain pharmacological interventions. This study suggests that an adapted multidisciplinary breathlessness support intervention is feasible and acceptable in a hospice context. However, to ensure optimal reach and maintenance of the intervention, activities are required to ensure that misconceptions about the setting do not influence willingness to accept referral to MBSS services and integration of services is needed to enable consistency in referral and discharge processes.

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