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:
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.