Table 3

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

Intervention	Predominant cycle of the BTF model	Evidence strength	Evidence origin	Practical comment
Pulmonary rehabilitation	Functioning	++++	Cochrane [47]	Patient may lack confidence and need one-to-one support or breathlessness service first.
Hand-held fan	Breathing	+++	[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 therapy	Thinking	++	[9, 50]	May require specialist psychological support.
Breathing techniques	Breathing	++	[9]	Need to be personalised, specialist respiratory physiotherapy advice required.
Inspiratory muscle training	Breathing	++	[9]	Needs to be personalised, specialist respiratory physiotherapy advice required.
Pedometer	Functioning	++	[9]	Pedometer training, e.g. as used by CBIS, increasing activity by 5% weekly from baseline.
Mindfulness-based stress reduction	Thinking	++	[9]	Requires 8-week course in standard evaluated form. Needs formal teaching even in abbreviated form.
Relaxation	Breathing	++	[9]	Various techniques, needs to be personalised.
Walking aids	Functioning	++	[51]	Should be standard assessment for every breathless individual, also possibly affects thinking via confidence.
Positioning	Breathing	+	[9]	Best position for individual may not fit standard ideas.
Acupuncture	Breathing?	+	[9]	Needs specialist training.