title: Episodes of breathlessness: types and patterns - a qualitative study exploring experiences of patients with advanced diseases.
abstract: BACKGROUND
  Despite the high prevalence and impact of episodic breathlessness, information about characteristics and patterns is scarce.
  
  
  OBJECTIVE
  To explore the experience of patients with advanced disease suffering from episodic breathlessness, in order to describe types and patterns.
  
  
  METHODS
  Qualitative design using in-depth interviews with patients suffering from advanced stages of chronic heart failure, chronic obstructive pulmonary disease, lung cancer or motor neurone disease. As part of the interviews, patients were asked to draw a graph to illustrate typical patterns of breathlessness episodes. Interviews were tape-recorded, transcribed verbatim and analysed using Framework Analysis. The graphs were grouped according to their patterns.
  
  
  RESULTS
  Fifty-one participants (15 chronic heart failure, 14 chronic obstructive pulmonary disease, 13 lung cancer and 9 motor neurone disease) were included (mean age 68.2 years, 30 of 51 men, mean Karnofsky 63.1, mean breathlessness intensity 3.2 of 10). Five different types of episodic breathlessness were described: triggered with normal level of breathlessness, triggered with predictable response (always related to trigger level, e.g. slight exertion causes severe breathlessness), triggered with unpredictable response (not related to trigger level), non-triggered attack-like (quick onset, often severe) and wave-like (triggered or non-triggered, gradual onset). Four patterns of episodic breathlessness could be identified based on the graphs with differences regarding onset and recovery of episodes. These did not correspond with the types of breathlessness described before.
  
  
  CONCLUSIONS
  Patients with advanced disease experience clearly distinguishable types and patterns of episodic breathlessness. The understanding of these will help clinicians to tailor specific management strategies for patients who suffer from episodes of breathlessness.
authors.affiliation: Department of Palliative Care, Policy & Rehabilitation - WHO Collaborating Centre for Palliative Care and Older People, Cicely Saunders Institute, King's College London, London, UK. simon@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 Em
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: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D004417:Dyspnea / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016472:Motor Neuron Disease / Q000150:complications*; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications*; D036301:Qualitative Research; D012307:Risk Factors; D011795:Surveys and Questionnaires
keywords: Dyspnoea; episode; palliative care; pattern; qualitative research; types