Abstract
BackgroundBreathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation.MethodsSystematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms.ResultsIn total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication.ConclusionsMore research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions.
Highlights
Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage
The terms breathlessness and dyspnoea are often used interchangeably and definitions focus on sensations of difficulty, discomfort and distress in breathing experienced by those affected [1,3,6], with perhaps the most authoritative definition coming from the American Thoracic Society in 1999: ‘...a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity
3576 were excluded based on the title/abstract as they were irrelevant studies, reviews but not systematic reviews, duplicates, laboratory studies or individual trials which were reported in an identified systematic review
Summary
Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. Breathlessness is a common symptom which occurs in a wide range of clinical conditions and affects many individuals [1]. Breathlessness often occurs in cancer, affecting 50-70% of patients [3]. Both frequency and severity of breathlessness increase towards the end of life [3,4,5]. The terms breathlessness and dyspnoea are often used interchangeably and definitions focus on sensations of difficulty, discomfort and distress in breathing experienced by those affected [1,3,6], with perhaps the most authoritative definition coming from the American Thoracic Society in 1999:. The experience derives from interactions among multiple physiological, psychological, social, and environmental factors, and may induce secondary physiological and behavioural responses’ [1]
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