• Steffen T Simon, Irene J Higginson, Hamid Benalia, Marjolein Gysels, Fliss Em Murtagh, James Spicer, and Claudia Bausewein.
• 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
• Palliat Med. 2013 Jun 1;27(6):524-32.

BackgroundDespite the high prevalence and impact of episodic breathlessness, information about characteristics and patterns is scarce.AimTo explore the experience of patients with advanced disease suffering from episodic breathlessness, in order to describe types and patterns.Design And ParticipantsQualitative 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.ResultsFifty-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.ConclusionPatients 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.

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