Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases

Source:
NICE Quality and Productivity Case Studies
Publisher:
Queen's University Belfast
Publication date:
12 December 2011

Abstract

NICE summary of review conclusions

Breathing training, walking aids, neuroelectrical muscle stimulation and chest wall vibration appear to be effective non-pharmacological interventions for relieving breathlessness in the advanced stages of some diseases.

The routine use of acupuncture or acupressure; distractive auditory stimuli (music); relaxation; fans; counselling and support programmes with or without relaxation and breathing training; case management; and psychotherapy to relieve breathlessness in the advanced stages of disease are not supported by sufficient good quality evidence. Consideration could be given to using it only in the context of a research or audit project.

Reducing the use of therapies for which there is no proven benefit and promoting those that do provide benefit may improve patient care and provide productivity savings.

 

The Implications for practice section of the Cochrane review stated:

Giving recommendations for the clinical setting is limited by the fact that most interventions were only tested in one patient group. Weighing up the findings of this review the following can be summarised:

  • The studies testing neuroelectrical muscle stimulation indicate strong evidence that this intervention is helpful to relieve breathlessness in COPD [chronic obstructive pulmonary disease] patients.
  • The studies evaluating chest wall vibration show that there is strong evidence that this intervention can relieve breathlessness in COPD patients. However, the practical implication of this intervention is unclear as the studies were only conducted in the respiratory laboratory.
  • The studies testing the use of walking aids (rollators) indicate moderate strength of evidence that there is some benefit for COPD patients with breathlessness.
  • The studies testing breathing training suggest that there is moderate strength of evidence that patients with breathlessness benefit from it.
  • There is not enough evidence to recommend the routine use of acupuncture/acupressure, distractive auditory stimuli (music), relaxation, fan, counselling and support programmes, counselling and support programmes in combination with relaxation and breathing training, case management, and psychotherapy. These interventions need further testing before they can be routinely used in clinical practice.

This review showed the big gap of evidence outside COPD. Many studies have been conducted either in the respiratory laboratory or in respiratory settings with little connection to palliative and end-of-life care. This review contributes to the need to view such interventions offered to participants with COPD or chronic heart failure from a palliative care perspective and will hopefully foster the cooperation between the different specialties to further improve the management of breathlessness in participants with advanced diseases.