Breathlessness can be one of the biggest hits to quality of life for those with COPD, but are you delving deep enough to help your patients take back control of their breathing?

Clinicians at the inaugural Australian COPD Symposium in Melbourne last week heard it was their responsibility to investigate the breathlessness in everyday life, given many patients don’t think their symptoms warrant explanation during regular check ups.

“A good conversation starter is, ‘What have you stopped doing to avoid breathlessness?’ clinical nurse consultant at Westmead Hospital, Sydney, Mary Roberts, told the audience.

“That opens up the conversation and you really get to understand the impact that [breathlessness] has.”

Once specialists have a good handle on how these symptoms are affecting everyday life, there are plenty of simple, evidence-based tools to equip patients to recover from breathlessness episodes, Ms Roberts said.

But as she and UTS Associate Professor Tim Luckett explained, many of these simply don’t get mentioned or aren’t taken up by patients.

Here are three everyday suggestions they say are worth incorporating into conversations with patients:

Breathing techniques and positioning 

During a breathlessness episode, patients with COPD try to gasp in air despite already being hyperinflated, Ms Roberts said. There was an opportunity to direct them towards breathing out instead to reestablish a calmer pattern.

“Focus on the breath out, then the breath in takes care of itself,” she said.

Rectangular breathing, where a patient matches their breathes in an out while visually tracing each side of a rectangular object, is one straightforward approach patients can achieve anywhere.

“Rectangles are everywhere – your TV, your iPad, your phone, a window… If you are breathless, it doesn’t matter where you are. Find a rectangle and breathe around it,” Ms Roberts said.

Teaching about breathing positions, which focus on releasing the shoulders during episodes of breathing difficulty, are also useful. They can be taught during pulmonary rehab, so patients can practice while knowing healthcare professionals are close by.

The humble handheld fan 

Several studies have now shown the benefits of handheld fan use for relieving breathlessness [link here], but while these tools cost well under $20 it’s been a slog to roll them out widely to patients.

Associate Professor Tim Luckett.

Associate Professor Tim Luckett, who works with the IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation) team at UTS Health, said there’s long been a belief that fans merely provided a placebo effect.

“We know now from quite a lot of experimental testing that they work through cooling the trigeminal nerve in the lower part of the face,” he said. 

“The benefits are really focused on recovery from exertional breathlessness – helping you get your breath back faster.” 

Despite this, many patients with COPD have never had fans mentioned to them, he said. The fact that they’re not a medical device, and this tricky to fund through health services, is a barrier.

But fans can give patients significant confidence that they can recover from breathlessness when they’re out and about, meaning it’s important to educate patiets about their value, Associate Professor Luckett said.

“The key thing is having a demonstration model, so that they know how it works.

“It’s all very well to tell [a patient] to go out and buy their own, but they may not believe you. If you can demonstrate to them that it works, they’re more likely to buy it.”

Energy conservation and the power of a bathrobe 

Talking to patients about the household tools they can use for energy conservation and to manage everyday tasks was also important, Ms Roberts said.

While many patients were reluctant to use tools like walking aids and shower chairs, clinicians should remind them of the need to “outsmart their breathlessness.”

One novel tool for this was to start using a terry towelling bathrobe, instead of a towel, for ease of drying after showering.

“I tell this to my patients. They get out of the shower, they’re dripping wet, they’re exhausted because they’ve been breathing in the heat,” she said.

“Rather than getting a towel and drying off… you get the bathrobe, you put it straight on after the shower, wrap it around you, sit on the loo and catch your breath.”

Ms Roberts had tried 20 different robes to work out the best option for patients, settling on an $40 option from IKEA which is the perfect length and absorption.

That simple strategy has had a big impact on many patients, she said, with many “going from not showering to showering themselves everyday, just by using a bathrobe.”