An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses

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.

The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: a feasibility randomised trial

“…Similar results were suggested by another systematic review, which was based on 16 trials on adults with COPD [9]. Our own systematic review more recently has added more information in the field and showed that IMT can be a potentially useful intervention for managing dyspnoea in non-cancer chronic respiratory diseases [5].…”

The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: a feasibility randomised trial

“…Similar results were suggested by another systematic review, which was based on 16 trials on adults with COPD [9]. Our own systematic review more recently has added more information in the field and showed that IMT can be a potentially useful intervention for managing dyspnoea in non-cancer chronic respiratory diseases [5].…”

Breathlessness in everyday life from a patient perspective: A qualitative study using diaries

“…Restriction in everyday life and limitation in physical activity have been described earlier both in patients with CHF (Edmonds et al, 2005) and COPD (Roche, 2009). In their article, Baily et al highlighted the importance of nonpharmacological management of breathlessness (Bailey et al, 2010) and in our study we could see how participants told about their different strategies coping with breathlessness in daily life.…”

Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results

“…For example, they reported raising the head of bed, using a fan blowing lightly toward patients' faces, using a cool mister, and using humidity with oxygen. Patients described the practice of deep, relaxed breathing and abdominal breathing, and alternating periods of rest with the use of a walker to maintain physical strength, which improved breathing (Bailey et al, 2010; Smothers & Buck, 2012). Furthermore, there was an improvement in breathlessness (39%) after completion of FamPALcare intervention ( p < 0.05).…”

The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: a feasibility randomised trial

“…Similar results were suggested by another systematic review, which was based on 16 trials on adults with COPD [9]. Our own systematic review more recently has added more information in the field and showed that IMT can be a potentially useful intervention for managing dyspnoea in non-cancer chronic respiratory diseases [5].…”

Breathlessness in everyday life from a patient perspective: A qualitative study using diaries

“…Restriction in everyday life and limitation in physical activity have been described earlier both in patients with CHF (Edmonds et al, 2005) and COPD (Roche, 2009). In their article, Baily et al highlighted the importance of nonpharmacological management of breathlessness (Bailey et al, 2010) and in our study we could see how participants told about their different strategies coping with breathlessness in daily life.…”

Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results

“…For example, they reported raising the head of bed, using a fan blowing lightly toward patients' faces, using a cool mister, and using humidity with oxygen. Patients described the practice of deep, relaxed breathing and abdominal breathing, and alternating periods of rest with the use of a walker to maintain physical strength, which improved breathing (Bailey et al, 2010; Smothers & Buck, 2012). Furthermore, there was an improvement in breathlessness (39%) after completion of FamPALcare intervention ( p < 0.05).…”

The effect of resistance inspiratory muscle training in the management of breathlessness in patients with thoracic malignancies: a feasibility randomised trial

“…Similar results were suggested by another systematic review, which was based on 16 trials on adults with COPD [9]. Our own systematic review more recently has added more information in the field and showed that IMT can be a potentially useful intervention for managing dyspnoea in non-cancer chronic respiratory diseases [5].…”

Breathlessness in everyday life from a patient perspective: A qualitative study using diaries

“…Restriction in everyday life and limitation in physical activity have been described earlier both in patients with CHF (Edmonds et al, 2005) and COPD (Roche, 2009). In their article, Baily et al highlighted the importance of nonpharmacological management of breathlessness (Bailey et al, 2010) and in our study we could see how participants told about their different strategies coping with breathlessness in daily life.…”

Verifying intervention fidelity procedures for a palliative home care intervention with pilot study results

“…For example, they reported raising the head of bed, using a fan blowing lightly toward patients' faces, using a cool mister, and using humidity with oxygen. Patients described the practice of deep, relaxed breathing and abdominal breathing, and alternating periods of rest with the use of a walker to maintain physical strength, which improved breathing (Bailey et al, 2010; Smothers & Buck, 2012). Furthermore, there was an improvement in breathlessness (39%) after completion of FamPALcare intervention ( p < 0.05).…”