TableĀ 3

Key non-pharmacological interventions used in managing breathlessness, with selected references

InterventionPredominant cycle of the BTF modelEvidence strengthEvidence originPractical comment
Pulmonary rehabilitationFunctioning++++Cochrane [47]Patient may lack confidence and need one-to-one support or breathlessness service first.
Hand-held fanBreathing+++[48, 49]Evidence suggests this reduces breathlessness recovery time, supports exercise, increases self-efficacy. No important adverse effects, use in all patients, giving advice on how/why used.
Cognitive behavioural therapyThinking++[9, 50]May require specialist psychological support.
Breathing techniquesBreathing++[9]Need to be personalised, specialist respiratory physiotherapy advice required.
Inspiratory muscle trainingBreathing++[9]Needs to be personalised, specialist respiratory physiotherapy advice required.
PedometerFunctioning++[9]Pedometer training, e.g. as used by CBIS, increasing activity by 5% weekly from baseline.
Mindfulness-based stress reductionThinking++[9]Requires 8-week course in standard evaluated form. Needs formal teaching even in abbreviated form.
RelaxationBreathing++[9]Various techniques, needs to be personalised.
Walking aidsFunctioning++[51]Should be standard assessment for every breathless individual, also possibly affects thinking via confidence.
PositioningBreathing+[9]Best position for individual may not fit standard ideas.
AcupunctureBreathing?+[9]Needs specialist training.