title: Non-pharmacological interventions for breathlessness in advanced stages of malignant and non-malignant diseases.
abstract: BACKGROUND
  Breathlessness is a common and distressing symptom in the advanced stages of malignant and non-malignant diseases. Appropriate management requires both pharmacological and non-pharmacological interventions.
  
  
  OBJECTIVE
  The primary objective was to determine the 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.
  
  
  METHODS
  We searched the following databases: 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 in June 2007. We also searched various websites and reference lists of relevant articles and textbooks.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  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 = 5), 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. There is not enough data to judge the evidence for distractive auditory stimuli (music), 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.
  
  
  CONCLUSIONS
  Breathing training, walking aids, NMES and CWV appear to be effective non-pharmacological interventions for relieving breathlessness in advanced stages of disease.
authors.affiliation: King's College London, Department of Palliative Care, Policy & Rehabilitation, Weston Education Centre, Denmark Hill, London, UK, SE5 9RJ. claudia.bausewein@kcl.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Bausewein
authors.forename: S
authors.initials: S
authors.lastname: Booth
authors.forename: M
authors.initials: M
authors.lastname: Gysels
authors.forename: I
authors.initials: I
authors.lastname: Higginson
mesh_terms: D015670:Acupuncture Therapy; D001945:Breathing Exercises; D019090:Case Management; D004417:Dyspnea / Q000209:etiology / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods; D006801:Humans; D009147:Music Therapy; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D012064:Relaxation Therapy; D014732:Vibration / Q000627:therapeutic use; D016138:Walking