Non-pharmacological interventions for use in breathlessness in the advanced stages of malignant and non-malignant diseases

Shortness of breath is a common and distressing symptom in incurable cancer and some other illnesses at the end of life. Overall shortness of breath towards the end of life is still difficult to treat. Appropriate treatment of this distressing symptom requires both drug and non-drug methods. We aimed to determine which non-drug methods relieve shortness of breath and which are the most effective. We found 47 studies that were first categorised in to two groups: methods with one clear described component and methods with a mixture of components. The two groups were then divided in to 12 subgroups. The following studies showed that these interventions can help to relieve shortness of breath: vibration of patient's chest wall, electrical stimulation of leg muscles, walking aids and breathing training. There are mixed results for the use of acupuncture/acupressure. Further interventions identified were counselling and support, either alone or in combination with relaxation-breathing training, music, relaxation, a hand-held fan directed at a patient's face, case management and psychotherapy. There are several non-drug methods available to relieve shortness of breath in incurable stages of cancer and other illnesses. There is currently not enough data to judge the evidence for these interventions. Most studies were conducted in participants with chronic lung disease. Only a few studies included participants with heart failure, cancer or neurological disease.