Breathlessness

Millions of people around the world live with breathlessness due to underlying medical conditions. It’s a problem that’s not often discussed yet has a major impact on their lives.

Simply put, these people can’t catch their breath. And when the problem gets worse it can lead to a crisis . In fact, it is responsible for as many as 20% of ambulance trips to the hospital.

But people who suffer from chronic breathlessness could often manage the problem at home better if only they were given support. This would avoid a potentially difficult experience for patients and their carers and prevent a wasted health service time and money for emergency departments.

Traditionally the management of patients with lung, heart and neuro-muscular diseases has focused only on the underlying disease – for example, the emphysema – without routinely looking at the impact that being out of breath over months and years has on patients’ everyday lives, or how that can be helped.

Here in the Wolfson Palliative Care Research Centre, we are carrying out research into breathlessness to positively impact the lives of those living with the symptom. We hope to enable patients to share their concerns about their ongoing breathlessness with doctors and nurses and for clinicians to ask patients routinely, and to share self-help techniques which can help relieve breathlessness. We are also developing and testing interventions in clinical trials using such techniques to see if they help, and can be afforded by the NHS.

Airflow studies

An exploratory systematic review and meta-analyses of airflow for the relief of chronic breathlessness in people with advanced disease
Many people live with continuing distress and difficulties arising from breathlessness despite treatment given to the underlying disease which causes it. This project addressed whether airflow provides relief of chronic breathlessness in people with advanced disease.

Calming Hand and Fan Feasibility trial (CHAFF)
This study looks at two options to help relieve breathlessness: a hand-held battery operated fan designed to give cool airflow to the face, and the Calming Hand, a simple breathing strategy that could help reduce anxiety that often occurs with breathlessness.

FanFIRST: Fan Feasibility Randomised Controlled Trial (RCT) for people living with COPD and high SABA intake
This study aims to assist COPD patients in managing breathlessness through the FanFIRST intervention, using the hand-held fan, positioning and other breathing techniques. The study's outcomes will determine the feasibility of a larger trial and potential implementation of the FanFIRST intervention within the NHS, potentially revolutionising COPD management.

Fan Facial Airflow Recovery from Exercise Patient Trial (FANFARE–P)
This study determined the ideal airflow rate from handheld fans to aid in recovering from breathlessness post-exercise for individuals experiencing chronic breathlessness. The results of this study, alongside a companion healthy participant study (FANFARE-H), will inform the design of an optimal handheld fan to facilitate quicker recovery from shortness of breath after physical activity.

Fan Implementation Study (FITS)
The study aimed to gather information on the use of the hand-held fan by healthcare professionals and how the COVID 19 guidance not to use the fan affected clinicians’ management of breathless patients. The study included interviews with clinicians working in the UK with breathless patients and a survey of clinician’s hand-held fan use in the Netherlands and the UK.

Multi-component studies

Breathlessness RElief AT HomE (BREATHE)
We want to see if we could run a research study that tests if paramedics trained in breathlessness techniques is more effective for people in breathlessness crisis than usual care in easing breathlessness and help more people stay at home. We have conducted feasibility work on this and are now planning to apply for funding for a definitive trial.

BREEZE 2
This project addresses the uncertainties relating to the design and conduct of a substantive phase 3 randomised controlled trial to evaluate a complex breathlessness intervention in patients with idiopathic pulmonary fibrosis (IPF) and chronic breathlessness. Previous feasibility work (BREEZE 1) showed this subsequent definitive trial was possible.

BREATHE-INDIA: BREATHlEssness in INDIA - Development of a breathlessness beliefs and behaviour education intervention for use in the community-setting
This study focuses on addressing persistent breathlessness in India, recognising its impact on disability, reduced workforce participation, and healthcare burden. The study will co-design a community-based education programme targeting breathlessness-related beliefs and behaviours, aiming to improve accessibility and effectiveness of interventions in resource-constrained regions like India.

Pharmacological studies to help breathing

BETTER-B: BETter TreatmEnts for Refractory Breathlessness An International, Multicentre, Randomised Controlled Pragmatic Trial of Mirtazapine to alleviate Breathlessness in Palliative and End of Life Care
BETTER-B will determine whether mirtazapine has a role in the management of chronic breathlessness in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). The purpose of the study is to test whether Mirtazepine is more effective in the relief of chronic breathlessness than placebo.

BreatheMOR-HF
Breathlessness is distressing for people with heart failure, and, as the condition worsens, may persist despite the best treatment. It’s already known breathlessness is safely improved by low-dose morphine in other conditions, such as cancer and chronic obstructive pulmonary disease. In this study, we tested if medium-term morphine therapy helps with breathlessness in heart failure patients.

Morphine and Breathlessness (MABEL)
Chronic breathlessness is common and very disabling in people with heart and lung conditions and cancer. We want to see if 10 to 20mg per day of oral morphine is better than dummy capsules at improving breathlessness.

Understanding the impact of breathlessness

Living with breathlessness: systematic review and qualitative synthesis
Living with breathlessness can be very difficult, affecting every area of life. However, there are things that can do to make life easier. This project reviewed the large body of research on breathlessness to understand how patients' quality of life can be improved.

ExacQual Study: Understanding people's experiences of exacerbations
Exacerbations of COPD are very distressing for patients and have long term consequences for their health. We want to explore patients and carers experiences, expectations and understanding of exacerbations and their help-seeking behaviour related to their exacerbations.

Bringing breathlessness into view
People living with breathlessness find their experience hard to describe to others. The aim of this project was to make an exhibition to show the public what it is like living with breathlessness.

Health service utilisation studies

Breathlessness and presentation to the emergency department: a survey and clinical record review
Breathlessness is a frequently occurring symptom of cardiorespiratory conditions and is a common cause of emergency department presentation. The aim of this study was to estimate the prevalence of acute-on-chronic breathlessness as a cause for presentation to the major emergencies area of the emergency department.