Managing breathlessness in patients with lung disease
7th February 2022
Research published last month demonstrates the need for better dissemination of guidelines for the management of breathlessness. Researchers carried out an online survey of doctors working in respiratory medicine and palliative care to find out how they managed chronic breathlessness in patients with COPD (Chronic Obstructive Pulmonary Disease), Interstitial Lung Disease and lung cancer. This is the first multinational survey conducted across Europe to compare the experiences and attitudes of physicians in the management of chronic refractory breathlessness in these conditions.
450 responses were analysed. Only 15% of respiratory medicine physicians and 17% of palliative care physicians reported that they knew of and had read carefully any local, national or international guidelines or recommendations on palliative care for non-malignant respiratory diseases.
The results showed substantial differences in the approach to clinical management of chronic refractory breathlessness between specialties, and between malignant and non-malignant lung disease. The findings suggest that knowledge of clinical practice guidelines influences evidence-based treatment choices, but there was also evidence of deviation from current recommendations, particularly related to the use of benzodiazepines.
There is a need for randomized clinical trials of new drug treatments, including antidepressants, to clarify clinical efficacy and reduce ambiguities in current practice recommendations. Most respiratory physicians welcomed the opportunity for shared care with palliative care colleagues.
The findings suggest a need for improved dissemination and uptake of jointly developed breathlessness management guidelines in order to encourage appropriate use of existing, evidence-based therapies. The lack of opioid use by respiratory medicine, and continued benzodiazepine use in palliative care, suggest that a wider range of acceptable therapies need to be developed and trialled.
Krajnik, M., Hepgul, N., Wilcock, A. et al. Do guidelines influence breathlessness management in advanced lung diseases? A multinational survey of respiratory medicine and palliative care physicians. BMC Pulm Med 22, 41 (2022). https://doi.org/10.1186/s12890-022-01835-0