title: Episodic and continuous breathlessness: a new categorization of breathlessness.
abstract: BACKGROUND
  Unlike pain, where the concept of breakthrough and background pain has been widely characterized and defined, breathlessness as a symptom has not yet been fully explored and has been rarely categorized.
  
  
  OBJECTIVE
  To explore patients' experiences and descriptions of breathlessness to categorize breathlessness.
  
  
  METHODS
  Qualitative study using in-depth interviews with patients suffering from four life-limiting and advanced diseases (chronic heart failure, chronic obstructive pulmonary disease, lung cancer, and motor neuron disease). Interviews were tape-recorded, transcribed verbatim, and analyzed using Framework analysis.
  
  
  RESULTS
  A total of 51 participants were interviewed (mean ± SD age 68.2 ± 11.6 years; 30 of 51 male; median Karnofsky 60%; mean ± SD breathlessness intensity 3.2 ± 1.7 of 10). Episodic breathlessness and continuous breathlessness were the main categories, with subcategories of triggered and non-triggered episodic breathlessness and continuous breathlessness for short and long periods. Episodic breathlessness triggered by exertion, non-triggered episodic breathlessness, and continuous breathlessness for a long period ("constant variable") were the most frequent and important categories with a high impact on daily living. Exertional breathlessness occurred in nearly all participants. Participants could differentiate episodic breathlessness (seconds, minutes, or hours) and continuous breathlessness (days, weeks, or months) by time. Episodic breathlessness occurred in isolation or in conjunction with continuous breathlessness.
  
  
  CONCLUSIONS
  Participants categorize their breathlessness by time and triggers. The categorization needs further verification, similar to that already established in pain, and can be used as a new evidence-based categorization to advance our understanding of this under-researched, yet high impact, symptom to optimize management.
authors.affiliation: Department of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom. steffen@steffensimon.de
authors.forename: Steffen T
authors.initials: ST
authors.lastname: Simon
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
authors.forename: Hamid
authors.initials: H
authors.lastname: Benalia
authors.forename: Marjolein
authors.initials: M
authors.lastname: Gysels
authors.forename: Fliss E M
authors.initials: FE
authors.lastname: Murtagh
authors.forename: James
authors.initials: J
authors.lastname: Spicer
authors.forename: Claudia
authors.initials: C
authors.lastname: Bausewein
mesh_terms: D000208:Acute Disease; D000368:Aged; D001049:Apnea; D002908:Chronic Disease; D004417:Dyspnea / Q000145:classification* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D012720:Severity of Illness Index; D009626:Terminology as Topic; D006113:United Kingdom