A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease

Johnson, Miriam J; Kanaan, Mona; Richardson, Gerry; Nabb, Samantha; Torgerson, David; English, Anne; Barton, Rachael; Booth, Sara

doi:10.1186/s12916-015-0453-x

Cited by 68Chronic Obstructive Pulmonary Disease (COPD) ResearchCancer survivorship and carePalliative Care and End-of-Life Issues

A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease

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Johnson, Miriam J, Kanaan, Mona, Richardson, Gerry, Nabb, Samantha, Torgerson, David, English, Anne, Barton, Rachael, Booth, Sara·2015·BMC Medicine

DOI 10.1186/s12916-015-0453-xPMC PMC4562360

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Abstract

BACKGROUND: About 90 % of patients with intra-thoracic malignancy experience breathlessness. Breathing training is helpful, but it is unknown whether repeated sessions are needed. The present study aims to test whether three sessions are better than one for breathlessness in this population. METHODS: This is a multi-centre randomised controlled non-blinded parallel arm trial. Participants were allocated to three sessions or single (1:2 ratio) using central computer-generated block randomisation by an independent Trials Unit and stratified for centre. The setting was respiratory, oncology or palliative care clinics at eight UK centres. Inclusion criteria were people with intrathoracic cancer and refractory breathlessness, expected prognosis ≥3 months, and no prior experience of breathing training. The trial intervention was a complex breathlessness intervention (breathing training, anxiety management, relaxation, pacing, and prioritisation) delivered over three hour-long sessions at weekly intervals, or during a single hour-long session. The main primary outcome was worst breathlessness over the previous 24 hours ('worst'), by numerical rating scale (0 = none; 10 = worst imaginable). Our primary analysis was area under the curve (AUC) 'worst' from baseline to 4 weeks. All analyses were by intention to treat. RESULTS: Between April 2011 and October 2013, 156 consenting participants were randomised (52 three; 104 single). Overall, the 'worst' score reduced from 6.81 (SD, 1.89) to 5.84 (2.39). Primary analysis [n = 124 (79 %)], showed no between-arm difference in the AUC: three sessions 22.86 (7.12) vs single session 22.58 (7.10); P value = 0.83); mean difference 0.2, 95 % CIs (-2.31 to 2.97). Complete case analysis showed a non-significant reduction in QALYs with three sessions (mean difference -0.006, 95 % CIs -0.018 to 0.006). Sensitivity analyses found similar results. The probability of the single session being cost-effective (threshold value of £20,000 per QALY) was over 80 %. CONCLUSIONS: There was no evidence that three sessions conferred additional benefits, including cost-effectiveness, over one. A single session of breathing training seems appropriate and minimises patient burden. TRIAL REGISTRATION: Registry: ISRCTN; TRIAL REGISTRATION NUMBER: ISRCTN49387307; http://www.isrctn.com/ISRCTN49387307 ; registration date: 25/01/2011.

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Breathlessness services providing predominantly non-pharmacological approaches are effective, cost-effective, and improve distress from breathlessness, mastery, quality of life, and survival.
“Such services provide a brief, cost-effective intervention that impacts positively on distress from breathlessness, mastery, quality of life, and even survival.”
From The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease (2017) · cites this paper as [27]
The Background and Discussion report benefits from non-pharmacological breathlessness interventions, including improvements in distress and mastery. The Results find a single breathing-training session likely cost-effective compared with three sessions, not compared with no service. The paper does not show that a breathlessness service improves survival; its Discussion attributes improved survival to a separate early-palliative-care trial. (LLM, conf=0.88)
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Additional file 1: of A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease
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Authors: Johnson, M. J., Kanaan, M., Richardson, G., Nabb, S., Torgerson, D., English, A., Barton, R., & Booth, S.
Affiliations: University of Hull (GB)
University of York (GB)
Humber Teaching NHS Foundation Trust (GB)
Castle Hill Hospital (GB)
University of Cambridge (GB)
Corresponding author: Johnson, Miriam J
ORCID: Johnson, Miriam J
Kanaan, Mona
Richardson, Gerry
Torgerson, David
English, Anne
Booth, Sara
Venue: BMC Medicine
Publisher: Springer Science and Business Media LLC
Published: 2015-09-07
Volume: 13
Issue: 1
Pages: 213-213
ISSN: 1741-7015 (ISSN-L)
DOI: 10.1186/s12916-015-0453-x
PMC: PMC4562360
OpenAlex: W2130234534
Cited by: 68
References: 40
Citations by year: 2026: 8 · 2025: 5 · 2024: 6 · 2023: 5 · 2022: 4 · 2021: 7 · 2020: 6 · 2019: 7 · 2018: 7 · 2017: 7 · 2016: 5 · 2015: 1
FWCI: 5.28
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: BMC Medicine (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Repository@Hull (Worktribe) (University of Hull) (publishedVersion, other-oa)
Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
Apollo (University of Cambridge) (submittedVersion, cc-by)
Apollo
Funders: National Institute for Health and Care Research (PB-PG-0609-19066)
University of Cambridge
Cambridge University Hospitals
University Hospitals Coventry and Warwickshire NHS Trust
Topics: Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
Keywords: dyspnea, malignant lung disease, refractory breathlessness, anxiety reduction, relaxation, pacing, priority setting, quality-adjusted life years, cost-effectiveness, palliative care, cancer care, respiratory care, symptom management
MeSH terms: Adult, Aged, Aged, 80 and over, Breathing Exercises, Cost-Benefit Analysis, Dyspnea, Female, Humans, Lung Neoplasms, Male, Middle Aged, Palliative Care, Quality-Adjusted Life Years

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A randomised controlled trial of three or one breathing technique training sessions for breathlessness in people with malignant lung disease

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