Breathlessness; the Experience for the Patient, an Approach for the Clinician

Intractable breathlessness is the most common devastating symptom of advanced cardio-respiratory disease, both malignant and non-malignant in nature. It is a global problem affecting millions of people worldwide as the incidence or COPD, lung cancer and heart failure continue to grow. Intractable breathlessness occurs when the uncomfortable sensation of the need to breathe persists even when the underlying medical condition and any other known aetiological factors have been maximally treated. In the most severe form it can be present at rest or on the most minimal exertion such as talking or washing. The fear and physical limitations the symptom imposes affects those closest to the patient as well, and over a period of years social isolation and depression are common both in the sufferer and the carers. There has been significant progress in recent years in understanding both the pathophysiology of breathlessness and ways it might be helped. This chapter sets out to outline both the experience of intractable breathlessness for patients and families and current best practice in managing the symptom.