Understanding Breathlessness: Causes, Effects, and Management

Breathlessness is a subjective sensation that varies among individuals and can be caused by various factors such as cancer, chronic respiratory disease, infections, and more. It affects a significant percentage of patients, particularly those with lung cancer. Understanding how breathlessness affects individuals and recognizing the associated feelings and physical signs can help in providing appropriate support and care.

• Breathing difficulties
• Lung cancer
• Respiratory health
• Symptom management
• Palliative care

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1. AREAS WE WILL COVER: What is breathlessness who does it affect? The impact of breathlessness Tool Box Changing your practice RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

2. WHAT IS BREATHLESSNESS? A subjective sensation The true nature of breathlessness is appreciated only by the person him/herself Unique to the individual Difficult to define: the underlying pathology may not correlate with the patient s perceptions of their symptoms . (Raynard and Ahmedzai 1990) RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

3. What is breathlessness caused by? Cancer itself Chronic Respiratory Disease Infection Pleural Effusion SVCO(Superior Vena Cava Obstruction) RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

4. Other causes: Cancer treatment e.g. radiotherapy, chemotherapy Ascites/abdominal distension Anaemia Fatigue Muscle weakness/cachexia (NB. Nutrition) RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

5. Who does it affect? 65% of lung cancer patients experience dyspnoea (Twycross 1986) Most common symptom along with cough (Higginson 1989) 70% of patients with cancer experience breathlessness in last 6 weeks of life (Higginson 1989) Historically a pharmacological approach used RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

6. How does someone with breathlessness feel? Scared Panic Helpless Hot Anxious Agitated Restless Tired/exhausted RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

7. How will they look? Sweaty Flushed Tired Uncomfortable Snatching at breath Agitated Blue RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

8. Someone who is breathless may say: I m going to die I need to open all the windows My chest feels tight I thought I was going to suffocate. is something terrible going to happen? I can t get enough air in RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

9. RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

10. THE IMPACT OF BREATHLESSNESS How does it feel? Frightening and debilitating experience Affects individual s ability to function Fighting for life/thoughts of death Panic/Anxiety Loss of control RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

11. Fatigue Restricted mobility Distress Sleep disturbance Fear of Suffocation Disruption in Relationships/sexual functioning BREATHLESSNESS Inability to perform ADL s Anxiety Inability to work Depression Restricted social functioning Financial Hardship RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

12. ENERGY RESOURCES REQUIRED FOR BREATHING At rest = 2.3% Heavy exercise = 3.4% Severe lung disease = over 33% (Naifeh 1994) RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

13. Factors Affecting Breathing: Activity Posture Heat/cold General disability Anxiety Pain RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

14. Breathlessness On Exertion Breathlessness At Rest Terminal Breathlessness Non pharmacological Approach Pharmacological Approach RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

15. Education: EMPOWERS the patient Basic anatomy and physiology of the lungs Reassurance breathlessness is not harmful Breathing is automatic with volume control awareness of breathing pattern, posture and body tension Speech and eating Breath holding RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

16. TOOL BOX RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

17. Tool Box: Coughing Huffing technique not to be done with residents with suspected/confirmed COVID-19 Frozen green grape Drinking iced drinks, lemon, lemon barley, buttercup syrup Lozenges, linctus Root ginger in boiling water inhale, drink Suck ice RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

18. Tool Box: Fan Schwartzstein et al, 1987 - not to be done with residents with suspected/confirmed COVID-19 Bath robe Shower-steam, window open, not too hot Provide walking aids Effort breathe out on exertion Stairs Walking Sit stand RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

19. Tool Box: Relaxation techniques visualisation - Deep breathing exercises - Music Meals smaller Drinking straws Jar of Energy Sleeping position RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

20. Tool Box: Breathing control: Increasing awareness of breathing pattern Efficient breathing - not snatching Expiration on effort Yogic breathing involving abdominals Rectangle breathing (this works really well!!) RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

21. POSITIONING: High side lying RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

22. POSITIONING: Relaxed sitting: RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

23. POSITIONING: Forward Lean Sitting RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

24. POSITIONING: Forward Lean Standing RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

25. Finally .................... Ask your patient what they find most useful when they are experiencing an episode of breathlessness you are then much better prepared to help them. Thank you RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

26. Case Study Lucy is a 64 year old lady with a four year diagnosis of breast cancer. She has been married for 40 years and has two grown up children both with their own families. She has always been very sociable and active. She lives in a house with stairs. Her breathlessness has been worsening for the past 12 months. She has been referred to us at the Martlets for breathlessness management. RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

27. Lucys description of her breathlessness: Beyond fear Terrifying Gasping Petrified Horrible Catch 22 situation Think you are going to die Drowning sensation Worst experience ever Life is dragged from you RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

28. Before Walls closing in Everything was a battle Quality of life Breathlessness controlling me Felt left out Lost part of my personality Losing friends Not a person an object RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

29. After Changed my life Took back control Saved my life Techniques work 100% Reasonably normal life Quality of life for first time in 18/12 No fear I can talk for England RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

30. Relationship with husband BEFORE AFTER Totally and utterly useless Unbelievable Headless chicken Fantastic Angry at him Comfortable, work together Didn t want to be alone with him Want to be with him now I wanted him to help Stronger between us RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

31. Coping strategies that Lucy learnt to use: Breathing control Awareness of next activity Talking when to take the next breath in Planning Pacing Use fans Don t rush Recognising early signs of anxiety RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020

32. Thank you for listening Any questions? RUTH EDWARDS. REHAB TEAM LEAD PHYSIOTHERAPIST - MARTLETS HOSPICE. March 2020