Rachel Williams Clinical Specialist Respiratory Physiotherapist Breathlessness Rachel Williams Clinical Specialist Respiratory Physiotherapist

Definition Uncomfortable awareness of one’s breathing, a subjective experience of breathing discomfort, air hunger subjective individual Practical exercise with straws- how does it feel?

Assessment It is important to ask what is causing the breathlessness at this time and is it reversible? is it disease process?- slowly increasing year on year in the case of COPD, variable from day to day with asthma is it sputum? is it anxiety and panic? is it a dysfunctional breathing pattern? is it issues with pacing and energy conservation? is it deconditioning? any other causes? or is it refractory- no reversible causes

Treatment breathing control techniques/sputum clearance pursed lipped breathing positioning pulmonary rehabilitation breathing retraining- dysfunctional breathers/vocal cord dysfunction anxiety management mindfulness and relaxation energy conservation and activity pacing ACBT, breathing control techniques, pursed lipped breathing, positions of rest

Treatment fan therapy- stimulation of the second and third branches of the trigeminal nerve pharmacological management- opioids, benzodiazepines?? palliative oxygen therapy - BTS oxygen guidelines 2015 Patients with cancer or end stage cardiorespiratory disease who are experiencing intractable breathlessness should NOT receive treatment with POT if they are non-hypoxaemic or have mild levels of hypoxaemia. Patients should receive assessment for a trial of treatment of opiods