title: Nonpharmacological interventions for breathlessness.
abstract: OBJECTIVE
  Breathlessness is difficult to palliate and nonpharmacological interventions are effective management strategies currently available for mobile patients. These are a diverse group of interventions, currently poorly defined and inconsistently used. This review concentrates on identifying and recommending the most effective nonpharmacological strategies for breathlessness, to aid clinical practice.
  
  
  RESULTS
  Much of the evidence presented is based on a Cochrane Review, which demonstrated that facial cooling, by handheld fan, mobility aids (e.g. rollators) and neuromuscular electrical stimulation all had evidence to support their use in breathlessness. Breathing exercises, pacing and positioning are frequently used to manage breathlessness, but need definition and further research. Anxiety reduction techniques and carer support are used in chronic disease management and applicable for breathlessness, but act indirectly. Exercise is a long established management strategy in both respiratory and other chronic diseases to maintain fitness (which reduces breathlessness) and increase psychological well being.
  
  
  CONCLUSIONS
  All patients with breathlessness should learn appropriate nonpharmacological interventions. Some can be taught by clinicians without specialist training, but others require specialist skills and high levels of engagement by cognitively intact and highly motivated people. Specialist breathlessness services may be more effective in delivering complex nonpharmacological interventions, but more research is needed.
authors.affiliation: Department of Palliative Care, University of Cambridge, UK. sara.booth@addenbrookes.nhs.uk
authors.forename: Sara
authors.initials: S
authors.lastname: Booth
authors.forename: Catherine
authors.initials: C
authors.lastname: Moffat
authors.forename: Julie
authors.initials: J
authors.lastname: Burkin
authors.forename: Sarah
authors.initials: S
authors.lastname: Galbraith
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
mesh_terms: D001007:Anxiety / Q000209:etiology / Q000628:therapy*; D001945:Breathing Exercises; D004417:Dyspnea / Q000150:complications / Q000523:psychology / Q000534:rehabilitation*; D004599:Electric Stimulation Therapy; D005081:Exercise Therapy / Q000379:methods*; D006801:Humans; D011187:Posture; D014853:Walkers