• Steffen T Simon, Vera Weingärtner, Irene J Higginson, Hamid Benalia, Marjolein Gysels, Fliss E M Murtagh, James Spicer, Philipp Linde, Raymond Voltz, and Claudia Bausewein.
• Department of Palliative Medicine, University Hospital of Cologne, Cologne, Germany; Center of Integrated Oncology (CIO) Cologne/Bonn, University Hospital of Cologne, Cologne, Germany; Institute of Palliative Care, Oldenburg, Germany. Electronic address: steffen@steffensimon.de.
• J Pain Symptom Manage. 2016 Aug 1; 52 (2): 228-34.

ContextEpisodic breathlessness causes additional distress to breathless patients with advanced disease, but management is still insufficient and there is a lack of knowledge on effective coping strategies.ObjectivesThe aim was to explore patients' self-management strategies for episodic breathlessness.MethodsIn-depth interviews with patients suffering from episodic breathlessness as a result of chronic heart failure, chronic obstructive pulmonary disease, lung cancer, or motor neuron disease were conducted. Interviews were transcribed verbatim and analyzed guided by the analytic hierarchy of Framework analysis.ResultsA total of 51 participants were interviewed (15 chronic heart failure, 14 chronic obstructive pulmonary disease, 13 lung cancer, and nine motor neuron disease; age, mean [SD], 68 [12], 41% women, median Karnofsky index 60%). They described six main strategies for coping with episodes of breathlessness: reduction of physical exertion, cognitive and psychological strategies, breathing techniques and positions, air and oxygen, drugs and medical devices, and environmental and other strategies. Some strategies were used in an opposing way, e.g., concentrating on the breathing vs. distraction from any thoughts of breathlessness or laying down flat vs. standing up and raising hands.ConclusionPatients used a number of different strategies to cope with episodic breathlessness, adding more detailed understanding of existing strategies for breathlessness. The findings, therefore, may provide a valuable aid for health care providers, affected patients, and their relatives.Copyright © 2016 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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