title: An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses.
abstract: BACKGROUND
  Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation.
  
  
  METHODS
  Systematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms.
  
  
  RESULTS
  In total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication.
  
  
  CONCLUSIONS
  More research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions.
authors.affiliation: Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK. c.d.bailey@soton.ac.uk
authors.forename: Chris D
authors.initials: CD
authors.lastname: Bailey
authors.forename: Richard
authors.initials: R
authors.lastname: Wagland
authors.forename: Rasha
authors.initials: R
authors.lastname: Dabbour
authors.forename: Ann
authors.initials: A
authors.lastname: Caress
authors.forename: Jaclyn
authors.initials: J
authors.lastname: Smith
authors.forename: Alex
authors.initials: A
authors.lastname: Molassiotis
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D001249:Asthma / Q000150:complications; D001993:Bronchodilator Agents / Q000627:therapeutic use; D004417:Dyspnea / Q000188:drug therapy* / Q000209:etiology*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000150:complications*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications; D000078202:Systematic Reviews as Topic
chemical_list: D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents