The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease

Spathis, Anna; Booth, Sara; Moffat, Catherine; Hurst, Rhys; Ryan, Richella; Chin, Chloe; Burkin, Julie

doi:10.1038/s41533-017-0024-z

Cited by 144 publications

(126 citation statements)

References 46 publications

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“…Breathing space resonates with the breathing, thinking, functioning clinical model [142]; a framework to help clinicians support patients with breathlessness to break the vicious cycles of physical, cognitive/ emotional and functional deterioration experienced by many.…”

Section: Discussionmentioning

confidence: 99%

Living with breathlessness: a systematic literature review and qualitative synthesis

et al. 2018

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What is the experience of people living with breathlessness due to medical conditions, those caring for them and those treating them, with regard to quality of life and the nature of clinical interactions?Electronic databases (Ovid MEDLINE, Embase, CINAHL Plus and PsycINFO) were searched (January 1987 to October 2017; English language), for qualitative studies exploring the experience of chronic breathlessness (patients, carers and clinicians). Two independent reviewers screened titles, abstracts and papers retrieved against inclusion criteria. Disagreements were resolved with a third reviewer. Primary qualitative data were extracted and synthesised using thematic synthesis.Inclusion and synthesis of 101 out of 2303 international papers produced four descriptive themes: 1) widespread effects of breathlessness; 2) coping; 3) help-seeking behaviour; and 4) clinicians' responsiveness to the symptom of breathlessness. The themes were combined to form the concept of "breathing space", to show how engaged coping and appropriate help-seeking (patient) and attention to symptom (clinician) helps maximise the patient's quality of living with breathlessness.Breathlessness has widespread impact on both patient and carer and affects breathing space. The degree of breathing space is influenced by interaction between the patient's coping style, their help-seeking behaviour and their clinician's responsiveness to breathlessness itself, in addition to managing the underlying disease.

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Section: Discussionmentioning

confidence: 99%

Living with breathlessness: a systematic literature review and qualitative synthesis

et al. 2018

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“…While chronic breathlessness cannot be cured, it can be managed with non-pharmacological and pharmacological therapies aimed at modulating the perception of breathlessness and the individual's response 6 . These therapies are ideally delivered within a self-management framework in which people learn skills to reduce the impact on functioning and sustain emotional wellbeing 7,8 .…”

Section: Introductionmentioning

confidence: 99%

Patient perspectives on how to optimise benefits from a breathlessness service for people with COPD

Luckett

Roberts

Smith

et al. 2020

npj Prim. Care Respir. Med.

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This study aimed to inform understanding of how to optimise patient-perceived benefits from a breathlessness service designed for patients with moderate to very severe chronic obstructive pulmonary disease (COPD). The Westmead Breathlessness Service (WBS) trains patients to self-manage over an 8-week programme, with multidisciplinary input and home visits. A qualitative approach was taken, using semi-structured telephone interviews. Each transcript was globally rated as suggesting ‘significant’, ‘some’ or ‘no’ impact from WBS, and thematic analysis used an integrative approach. Forty-one consecutive participants were interviewed to reach ‘information power’. Eighteen (44%) participants reported ‘significant’ impact, 17 (41%) ‘some’ impact, and two (5%) ‘no’ impact. Improvements to breathlessness were usually in the affective and impact dimensions but, more uncommonly, also sensory-perceptual. Participants who benefited in self-esteem, confidence and motivation attributed this to one-to-one multidisciplinary coaching and home visits. Further research should test whether including/excluding more intensive programme elements based on individual need might improve cost-effectiveness.

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“…As such, currently several clinical trials are under way and focusing on new therapeutic approaches. Furthermore, the research field in IPF is expanding to Graphic expression (comorbidome) of comorbidities with >10% prevalence in the entire cohort, and those comorbidities with the strongest association with mortality (hazard ratio (HR) >1, 95% CI >1; p<0.05) [166]. The area of the circle relates to the prevalence of the disease.…”

Section: Discussionmentioning

confidence: 99%

“…Breathlessness can be an emotionally frightening and disabling symptom affecting mobility and quality of life and a breathing, thinking and functioning clinical model has been proposed to tackle this symptom [166]. Pulmonary rehabilitation is just one of many interventions that has been used to improve breathlessness.…”

Section: New Ways To Approach Palliative Interventionmentioning

confidence: 99%

The therapy of idiopathic pulmonary fibrosis: what is next?

et al. 2019

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive, fibrosing interstitial lung disease, characterised by progressive scarring of the lung and associated with a high burden of disease and early death. The pathophysiological understanding, clinical diagnostics and therapy of IPF have significantly evolved in recent years. While the recent introduction of the two antifibrotic drugs pirfenidone and nintedanib led to a significant reduction in lung function decline, there is still no cure for IPF; thus, new therapeutic approaches are needed. Currently, several clinical phase I–III trials are focusing on novel therapeutic targets. Furthermore, new approaches in nonpharmacological treatments in palliative care, pulmonary rehabilitation, lung transplantation, management of comorbidities and acute exacerbations aim to improve symptom control and quality of life. Here we summarise new therapeutic attempts and potential future approaches to treat this devastating disease.

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The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease

Cited by 144 publications

References 46 publications

Living with breathlessness: a systematic literature review and qualitative synthesis

Living with breathlessness: a systematic literature review and qualitative synthesis

Patient perspectives on how to optimise benefits from a breathlessness service for people with COPD

The therapy of idiopathic pulmonary fibrosis: what is next?

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