Abstract
Chronic breathlessness reaches beyond symptom perception into the realm of functional impairment and disability http://ow.ly/IBRd30h1wmS
From the authors:
We agree with much presented in O.K. Faull and colleagues' response to our proposed chronic breathlessness syndrome and thank them for their views supporting chronic breathlessness as more than just a symptom [1]. In particular, we agree that naming and defining chronic breathlessness as a syndrome does not aim, or need, to constrain a recognition or understanding of quantitative and qualitative between-individual differences. We agree that our intention is to ensure patients and their families living with the daily disability affecting all domains of life, irrespective of cause, may legitimately bring this experience to the attention of health and social professionals, receive a systematic assessment and subsequently benefit from individually tailored evidence-based management.
There are two issues for comment. Firstly, O.K. Faull and colleagues appear to equate breathlessness with primarily a sensory, effective and cognitive perception. However, the foremost burden of chronic breathlessness is not sensory, but rather the functional confinement that breathlessness imposes on an individual. In chronic breathlessness, affective and cognitive perceptions relate more to loss of function, socialisation and fulfilment, and to fear of suffocation and death. Chronic breathlessness syndrome highlights that the impact of this condition reaches well beyond the unpleasant perceptions of, and emotional response to, a symptom into the realm of functional impairment and disability. This concept is illustrated well in recently published practical clinical assessment and management approaches to chronic breathlessness, the Breathing, Thinking, Functioning and Breathing SPACE models [2, 3].
Secondly, the use of the term reductionist is unhelpful as implied by O.K. Faull and colleagues, that is, a syndrome attempts the impossible; a complex idea cannot be completely understood in terms of its components and an attempt to do so is foolish. However, reductionist may also be used in the sense of analysing “complex things into less complex constituents” [4]. “Breathlessness persists despite optimal treatment and causes disability” [1] for many, yet remains almost totally invisible to most health and social care professionals. Therefore chronic breathlessness needs an identifiable profile in order to bring patient experience into view, help them access evidence-based interventions and stimulate research into the complexity of breathlessness in order to identify future therapeutic targets. Already, the work of O.K. Faull and colleagues has increased our understanding that perception of chronic breathlessness (experienced by patients) compared with that in healthy volunteer models is different; but much more research is needed [5]. If reducing the complex to recognisable components in clinical practice helps clinicians to routinely assess patients, helps patients have their concerns heard, helps carers to seek support and understanding, and helps services to develop and research to grow, then the reduction of chronic breathlessness to a syndrome will have made a major difference to the lives of many.
Disclosures
Supplementary Material
D.Currow ERJ-02326-2017_Currow
Footnotes
Conflict of interest: Disclosures can be found alongside this article at erj.ersjournals.com
- Received November 20, 2017.
- Accepted November 21, 2017.
- Copyright ©ERS 2018