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Many people with lung and heart conditions live with breathlessness every day. Even when they receive good medical care, managing this distressing symptom stops people doing simple day-to-day activities. Many people with chronic breathlessness and their family/carers experience anxiety, depression and social isolation. Chronic breathlessness is a frequent reason for ED visits and hospital admissions, resulting in high health care costs for services, out-of-pocket expenses and increased care and support needs provided by carers.
Internationally, growing research evidence supports the use of symptom-based care to lessen the effects of breathlessness on the quality of life and distress to families. There is compelling evidence that in the year after receiving brief symptom-based interventions through a Breathlessness Intervention Service (BIS), unplanned hospital admissions reduce by as much as 50-60%. Despite this, there are few available services in Australia, including the ACT, that focus on the management of this troubling symptom.
CHN engaged University of Technology Sydney (UTS), Southside Physio (SSP) and consumers and clinicians to co-design and develop a pilot of a Breathlessness Intervention Service in the ACT. The Breathlessness Intervention Service is addressing the local primary and community care needs. This pilot will contribute towards growing evidence about how a BIS could work best for our local community. It will also highlight to clinicians in the ACT the non-pharmacological interventions, including engagement of Allied Health practitioner’s role in managing breathlessness to reduce distress and improve quality of life of patients and their carers.
The 12-month ABIS Pilot program was delivered by the Southside Physio multi-disciplinary team. Requiring a GP referral, the client receives an initial home visit by a Physiotherapist, with 2 to 4 follow-ups at home or by phone by a Nurse or Physiotherapist. Interventions are non-pharmacological and address the ‘Breathing, Thinking and Functioning’ components of breathlessness. Interventions are aimed at both patient and/or their carer. Similar pilot has been trialled in the UK.
Key outcomes
- ABIS opened referrals from general practice in March 2023 and 24 eligible patients have received at least one home consultation and 6 patients have finished the ABIS program.
- A one-day face-to-face workshop was delivered to 34 clinicians on the ‘Mastery of Breathlessness’, including the Southside Physio multi-disciplinary team delivering ABIS.
- Ethics approval was granted for collection of quantitative data of patient and carer outcome measures and qualitative data from patient, care and referring health professional interviews feeding into a rolling analysis to inform improvement strategies via a co-design process.
Client story
Tony* (not their real name) was referred to the ACT Breathlessness Intervention Service (ABIS) program with a history of chronic obstructive pulmonary disease, severe osteoarthritis and hypertension. Tony loved his garden and produced almost all of his food himself. He also had a great love and passion for producing several products from his olive trees.
Due to being anxious about feeling breathless, Tony reduced his activity level severely. This led to an increase in pain due to his osteoarthritis, which then further reduced his activity level.
Through the ABIS program, we increased Tony’s activity level using a slow introduction to some functional activities, around and inside his house. Due to the education given, Tony was not scared or anxious to go into a state of being breathless and could manage it with breathing techniques. Slowly his osteoarthritis pain improved, and he managed a higher level of activity. Initially he seriously considered knee replacements, but after completing the program his pain reduced enough to go without surgery.
In our last session, Tony managed to have his olive trees in full production mode. Tony was loving every moment of it and was so appreciative of what the program meant to him.
