Non drug interventions to reduce breathlessness in patients with Chronic Obstructive Pulmonary Disease (Emphysema)

After the clinic assessment, subjects will receive a range of interventions to address their breathlessness. These are derived from evidence based interventions and will include breathing techniques, positions to aid breathing, a hand held fan (supported by a Breathlessness DVD- made by Westmead Hospital based on existing literature supervised by Clinical nurse consultant in respiratory medicine with more than 20 years experience) relaxation and breathing strategies supported by a custom made CD (made by Westmead Hospital specifically for this clinic with input from a psychologist with greater than 10 years clinical experience), basic advice about pacing activities, a walking program and nutritional advice. Patient handouts have been developed to reinforce the advice given in clinic. Interventions will be individualised for individuals. This will occur as part of the multi-disciplinary team meeting which involves personnel form the disciplines of medicine, nursing, physiotherapy, occupational therapy, dietetics and clinical psychology. Each individuals treatment will be dictated by their clinical needs. Adherence with suggested interventions will be assessed at weekly multidisciplinary meetings and recorded in trial database. Duration of the intervention will be for 8 weeks. Breathing techniques are essentially pursed lip breathing and ‘breathing around the rectangle’ which reduces dynamic hyperinflation. Patients are advised to practise these techniques when they are breathless until the breathlessness episode resolves. Positions essentially involve lean forward postures with arms supported to aid recover from breathless episodes. Relaxation involves assessing patients psychological reaction to breathless episodes and suggesting individualised advice depending on patients’ needs. Basic advice about pacing includes the importance of planning activities of daily living and utilising strategies which allowed the activity to be broken into a number of steps and undertaking each step as breathlessness and energy levels allow. A walking program involves assessing patients physical activity using a pedometer and suggesting goal step counts for patients who are able to increase their step counts. The walking program will be customised to each patients based on their step count during the first week. Nutritional advice involves assessing the patients weight and food intake. Patients with low BMI or who are found to be malnourished or at risk of malnutrition using the Mini Nutritional assessment will receive further input from a dietitian with 15years experience. The delivery of the intervention will be different for patients and will depend on their needs and previous experiences with breathlessness. All patients will receive some advice in the initial clinic appointment. This clinic is delivered by a clinical nurse consultant with more the 20 years’ experience and a respiratory physician with training in palliative care with almost 20 years post graduate experience. The clinic visit lasts approximately one hour. This initial clinic advice will be supported by a range of handouts developed for this clinic. Following initial assessment, patients will receive further advice on the above techniques depending on their need. This advice will be delivered by face to face assessments supported by phone calls. Clinicians involved in delivering this advice include a physiotherapist, occupational therapist and clinical nurse consultant.