Multidisciplinary, non-pharmacological breathlessness intervention service for patients with moderately severe to severe COPD: a randomised controlled trial

Clinical Snapshot

Key Findings

• P Value: p=0.0262

• Effect Size: Between-group difference 0.5 units (95% CI 0.2 to 0.8)

• Primary Outcome: CRQ-Mastery improved by 0.5 units in intervention group compared to control

• Nnt Or Sensitivity: Effect size meets minimal clinically important difference threshold of 0.5 units for CRQ subscales

• Confidence Interval: 95% CI 0.2 to 0.8

Clinical Application

Requires multidisciplinary team including respiratory physiotherapists, occupational therapists, and dietitians; 8-week program duration manageable in clinical practice Conducted in Australian healthcare setting (Western Sydney LHD); intervention components align with COPD-X guidelines and could be integrated into existing pulmonary rehabilitation programs or respiratory outpatient services Adults with moderate to severe COPD (FEV1 ≤60% predicted) experiencing disabling breathlessness (mMRC ≥2) in respiratory clinic settings

Abstract

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an often-progressive respiratory disease associated with disabling breathlessness. Breathlessness intervention services (BIS), which coach patients to self-manage breathlessness using non-pharmacological strategies, are effective in a variety of populations, including those with cancer and serious respiratory disease. This study aimed to compare the impact of the Westmead Breathlessness Service in people with moderate to severe COPD. METHODS: We analysed 113 participants randomised (1:1) with moderate/severe COPD (forced expiratory volume in 1 s (FEV1)/forced vital capacity <0.70 and FEV1 ≤60% predicted) and disabling breathlessness (modified Medical Research Council (mMRC) Breathlessness Score ≥2) to either an 8-week intervention involving breathing techniques, handheld fan use, exercise, energy conservation, dietetic advice (n=54) or 8-week wait-list control group (n=59). The primary outcome was change in Chronic Respiratory Questionnaire (CRQ) Mastery of breathlessness subscale. Secondary outcomes included change in other CRQ subscales (Fatigue, Emotion and Dyspnoea), exertional breathlessness intensity/unpleasantness (0-10 Numerical Rating Scale Score), anxiety and depression. Difference in change over 8 weeks between groups was compared using ANCOVA; p<0.05 statistically significant. FINDINGS: Participants were aged 70.9 (±8.5) years, 50% female, mean FEV1 =0.8 L (±0.3 L; 34% predicted), mMRC Breathlessness Score 3 (IQR 3-4). CRQ-Mastery improved following intervention compared with control (between-group difference 0.5 units; 95% CI 0.2 to 0.8; p=0.0262) using modified intention-to-treat analysis. Better CRQ-Dyspnoea and CRQ-Fatigue were seen in the intervention group (between-group difference-CRQ-Dyspnoea 0.4 units; CI 0.1 to 0.7; p=0.005, and CRQ-Fatigue 0.4 units; CI 0.1 to 0.7; p=0.014). Exertional breathlessness intensity (difference -0.8 units; CI -1.4 to -0.2; p=0.013) and breathlessness unpleasantness (difference -1.2 units; CI -1.7 to -0.6; p=0.001) also improved. INTERPRETATION: An 8-week BIS improved CRQ-Mastery, Dyspnoea and Fatigue, exertional breathlessness intensity and unpleasantness in people with severe COPD.

References

1. 1.Smith, T. A., Roberts, M. M., Luckett, T., Cho, J. G., Klimkeit, E., Stephenson, H., McCaffrey, N., Kirby, A., & Wheatley, J. R. (2026). Multidisciplinary, non-pharmacological breathlessness intervention service for patients with moderately severe to severe COPD: a randomised controlled trial. Thorax. https://doi.org/10.1136/thorax-2025-223457