Non‐pharmacological interventions for breathlessness in advanced stages of malignant and non‐malignant diseases
Abstract
Background
Breathlessness is a common and distressing symptom in advanced stages of malignant and non‐malignant diseases. Appropriate management requires both pharmacological and non‐pharmacological interventions.
Objectives
Primary objective was to determine effectiveness of non‐pharmacological and non‐invasive interventions to relieve breathlessness in participants suffering from the five most common conditions causing breathlessness in advanced disease.
Search methods
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, British Nursing Index, PsycINFO, Science Citation Index Expanded, AMED, The Cochrane Pain, Palliative and Supportive Care Trials Register, The Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews of Effectiveness were searched in June 2007.
Selection criteria
We included randomised controlled and controlled clinical trials assessing the effects of non‐pharmacological and non‐invasive interventions to relieve breathlessness in participants described as suffering from breathlessness due to advanced stages of cancer, chronic obstructive pulmonary disease (COPD), interstitial lung disease, chronic heart failure or motor neurone disease.
Data collection and analysis
Two review authors independently assessed relevant studies for inclusion. Data extraction and quality assessment was performed by three review authors and checked by two other review authors. Meta‐analysis was not attempted due to heterogeneity of studies.
Main results
Forty‐seven studies were included (2532 participants) and categorised as follows: single component interventions with subcategories of walking aids (n = 7), distractive auditory stimuli (music) (n = 6), chest wall vibration (CWV, n = 5), acupuncture/acupressure (n = 5), relaxation (n = 4), neuro‐electrical muscle stimulation (NMES, n = 3) and fan (n = 2). Multi‐component interventions were categorised in to counselling and support (n = 6), breathing training (n = 3), counselling and support with breathing‐relaxation training (n = 2), case management (n = 2) and psychotherapy (n = 2).
There was a high strength of evidence that NMES and CWV could relieve breathlessness and moderate strength for the use of walking aids and breathing training. There is a low strength of evidence that acupuncture/acupressure is helpful and no evidence for the use of music. There is not enough data to judge the evidence for relaxation, fan, counselling and support, counselling and support with breathing‐relaxation training, case management and psychotherapy. Most studies have been conducted in COPD patients, only a few studies included participants with other conditions.
Authors' conclusions
Breathing training, walking aids, NMES and CWV appear to be effective non‐pharmacological interventions for relieving breathlessness in advanced stages of disease.
Plain language summary
Non‐pharmacological interventions for use in breathlessness in the advanced stages of malignant and non‐malignant diseases
Shortness of breath is a common and distressing symptom in incurable cancer and some other illnesses at the end of life. Overall shortness of breath towards the end of life is still difficult to treat. Appropriate treatment of this distressing symptom requires both drug and non‐drug methods. We aimed to determine which non‐drug methods relieve shortness of breath and which are the most effective. We found 47 studies that were first categorised in to two groups: methods with one clear described component and methods with a mixture of components. The two groups were then divided in to 12 subgroups. The following studies showed that these interventions can help to relieve shortness of breath: vibration of patient's chest wall, electrical stimulation of leg muscles, walking aids and breathing training. There are mixed results for the use of acupuncture/acupressure. Further interventions identified were counselling and support, either alone or in combination with relaxation‐breathing training, music, relaxation, a hand‐held fan directed at a patient's face, case management and psychotherapy. There are several non‐drug methods available to relieve shortness of breath in incurable stages of cancer and other illnesses. There is currently not enough data to judge the evidence for these interventions. Most studies were conducted in participants with chronic lung disease. Only a few studies included participants with heart failure, cancer or neurological disease.
