Management of breathless patient (chest physio)

Question 1

What is good breathing?

Answer 1

• Effortless
• Quiet
• Regular
• Use of diaphragm and intercostal muscles to expand lungs

Question 2

what is the cycle of breathing difficulties

Answer 2

SOB –> shallow breathing –> tense muscles –> getting anxious –> worse SOB –> limiting your activities –> increasing anxiety –> SOB …..and so on

Question 3

describe use of accessory muscles

Answer 3

Patients use them to compensate for difficulty breathing but is actually extra effort and is an exhausting way to breath

Question 4

how can positioning help breathing

Answer 4

Upright position is best as diaphragm is in a better position (gravity) with open chest/shoulders
Ensure patient is comfortable and relaxed: anxiety plays a role in breathing difficulties
Can use lumbar rolls which puts spine into correct position and avoids slumping
Can lean on a chair or table, or if out lean against a wall to relax and catch breath

Question 5

what techniques in addition to positioning are there

Answer 5

• Diaphragm breathing: sit upright with one hand on tummy and one on chest- the hand on your chest shouldn’t move, hand on tummy should move out when breathing in, and in when breathing out. Encourage to practice when not breathless so when they do become breathless they know how to do it, reduces panic
• If anxiety/panic plays a role, encourage to just focus on breathing out- get to sigh, huff, laugh, blow bubbles, etc
• Have something to lean on and cushions to aid maintenance of position
• Sometimes having a small drink of water can help (not if really gasping for breath), especially good if they have secretions or are on oxygen therapy
• Have cool environment – having a fan can help
• Use appropriate touch e.g. hand on back
• Relaxation techniques

Question 6

explain pace, practise, prioritise

Answer 6

• Pace: what a person could have done before will change now they struggle with breathlessness and may not be able to do everything in one go anymore e.g. getting ready in the morning or tidying the kitchen- encourage to do things in lots of little stages to avoid becoming breathless
• Prioritise: encourage person to work out what is most important part of their day to them and prioritise that e.g. if they have grandkids coming round later, don’t do all the ironing then become breathless and exhausted
• Practise: practice diaphragm breathing when not breathless

Question 7

how can carers be effect when caring for someone with breathlessness

Answer 7

“Those who care for breathless patients report high levels of unmet needs and burden, equally severe for heart failure and lung cancer caregivers. Caregivers of patients with more severe breathlessness report fewer positive caring experiences and should be targeted by services with increased support in managing this symptom.”

The consequences of living with breathlessness are multidimensional and arise in all aspects of daily life of patients, their family caregivers and their social environment. Multidimensional treatment programmes should become widely available to support patients with advanced disease and their family caregivers in coping with the functional, psychological and social consequences of living with breathlessness.