Understanding persistent breathlessness: impact on patients and optimal approaches to symptomatic reduction – an overview

ABSTRACT

Introduction

Persistent breathlessness (breathlessness persisting despite optimal treatment for the underlying condition and resulting in disability) is a prevalent syndrome associated with chronic and life-limiting conditions. Improving the clinical recognition and assessment of persistent breathlessness is essential to ensure people are provided with the best treatment for optimal symptom control.

Areas covered

This overview focuses on the impact of persistent breathlessness on patients, carers and the health system. It highlights the importance of identifying persistent breathlessness in clinical consultations, suggests steps to recognize this syndrome and discusses the evidence for non-pharmacological and pharmacological treatments in this context. Future research directions are also suggested.

Expert opinion

Persistent breathlessness is often invisible because 1) people may not engage with the health system and 2) both clinicians and patients are reluctant to discuss breathlessness in clinical consultations. Improving the recognition and assessment of this syndrome is critical to facilitate meaningful conversations between patients and clinicians and ensure patient-centered care. Non-pharmacological strategies are key to improving symptom management and health outcomes. Regular, low-dose, sustained-release morphine may help further reduce breathlessness in people who remain symptomatic despite disease-specific and non-pharmacological therapies.

KEYWORDS:

• Chronic breathlessness
• evidence-based care
• palliative care
• persistent breathlessness
• quality of life
• suffering
• symptom assessment
• symptom management

Article highlights

• Persistent breathlessness is highly prevalent in people with chronic and life-limiting illnesses and significant at an individual, health system and societal level.

• Its true impact remains understated because of patients’ and clinicians’ reluctance to raise the topic in routine clinical consultations.

• Improved clinical recognition of the presence, severity and impact of persistent breathlessness will facilitate more timely, tailored symptom management and person-centered care.

• Treatment should involve: 1) treating reversible aspects of underlying disease(s); 2) non-pharmacological measures; and, if necessary, 3) pharmacological treatment.

• Efficacy of non-pharmacological interventions will be enhanced if they are delivered in integrated models of care and with multi-component approaches that respond to impacted domains of personhood.

• Despite conflicting evidence and wide inter-individual response, regular, low-dose, sustained-release morphine 10-30 mg/day is the only pharmacological treatment currently licensed for the symptomatic reduction of persistent breathlessness.

Acknowledgments

The authors thank Ms. Debbie Marriott for her ready assistance and for her expertise in article formatting and submission.

Declaration of interest

D Currow is an unpaid advisory board member for Helsinn Pharmaceuticals. He is a paid consultant and receives payment for intellectual property with Mayne Pharma and is a consultant with Specialised Therapeutics Australia Pty. Ltd. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This work was not funded.