Chronic breathlessness which is refractory to treatments for the underlying condition is a common symptom of frequently encountered conditions that present in primary care, including lung and heart disease, and cancer. Primary-care based chronic illness initiatives such as clinics for asthma or chronic obstructive pulmonary disease (COPD) and community heart nurse specialists play a vital role in optimising the management of the underlying condition(s), but for many people, especially in the later stages of the disease, breathlessness persists (chronic refractory breathlessness). Chronic refractory breathlessness is distressing for patients, their families and other caregivers, and for clinicians.
Clinical Question
What can the primary care practitioner offer patients with chronic breathlessness at rest or on minimal exertion which is refractory to treatments directed at the underlying cause of the symptom?
Clinically, chronic refractory breathlessness is a distinct entity, rather than simply a failure to treat the underlying condition(s). It requires a different approach than that required for acute breathlessness brought on, for example, by acute coronary syndrome, an acute exacerbation of COPD, or acute pneumonia.
