Yates, P., & Zhao, I. (2012). Update on complex nonpharmacological interventions for breathlessness. Current Opinion in Supportive and Palliative Care, 6(2), 144-152.

The objective of the article is to report on strategies that patients with breathlessness find helpful and provide a review of current evidence about the role of nonpharmacologic interventions in managing dypsnea.

This article reports a secondary analysis of data from a trial in which self-report items were used to assess the impact of dyspnea on daily activities, feelings about breathlessness, and strategies adopted by patients. Authors also review the findings of several systematic reviews of nonpharmacologic interventions for breathlessness involving patients with chronic obstructive pulmonary disease (COPD) as well as lung cancer.

• The article reported on a sample of 144 patients.
• The mean age was 67.9 years (SD = 9.6 years).
• The sample was 60% males and 40% females.
• Patients involved in self-report of strategies all had cancer. 
• Most data from systematic reviews involved primarily patients with COPD.

The multi-site study was conducted in an unspecified setting in Australia.

• Patients were undergoing end-of-life care.
• The article has clinical applicability for palliative care.

Descriptive

• Author-designed self-report instrument based on an assessment guide developed in the UK
• Likert-type scoring on a 4-point scale

About half of patients reported that breathlessness had some effect on feelings of panic, fear, and anger. Activity modification was the most frequently used strategy.  Cognitive coping strategies were used by 80% of respondents. Other strategies included breathing exercises and environmental modifications. The most helpful strategies related to activity modification. Of those who used coping and breathing exercises, 60% said they were helpful. Breathing retraining was found to be effective but is mainly studied in COPD. Exercise program findings are inconclusive, and interventions to reduce anxiety have had some positive outcomes. Other interventions such as music, distraction, and complementary medicine have insufficient evidence.

Patients in this study reported that activity management was helpful to manage dyspnea.

• Risk of bias (no control group)
• Risk of bias (no blinding) 
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition) 
• Risk of bias (sample characteristics)
• Measurement validity/reliability questionable
• The likert scale used is questionable in terms of lack of differentiation in terms used for degree of effect.
• Findings reported from systematic reviews were mainly from COPD cases, and few included patients with lung cancer. 
• Other cancers were not included.

Findings suggest that educating appropriate patients about activity management can be helpful for them to manage symptoms of dyspnea. Limited evidence exists about the effects of other nonpharmacologic approaches that are effective for patients with cancer.