Non-pharmacological strategies like breathing techniques and positioning help COPD patients manage acute episodes and improve confidence.

By Valery Butto


RT’s Three Key Takeaways:

  1. Emergency Care Reduction: Survey data showed 67% of patients using breathlessness action plans avoided calling an ambulance in the previous year.
  2. Common Strategies: Most analyzed plans relied on breathing techniques, positioning, and airflow strategies to help patients manage acute-on-chronic episodes.
  3. Usability Gaps: While promising, many existing plans have mixed quality with a median reading grade of 8.2, suggesting they may be too complex for some patients.


Non-pharmacological breathlessness action plans may help people with chronic obstructive pulmonary disease (COPD) manage acute episodes and avoid emergency care, according to a scoping review and survey of current practice published in the International Journal of Chronic Obstructive Pulmonary Disease.

Breathlessness action plans are designed to help patients respond to acute-on-chronic episodes of breathlessness using non-pharmacological strategies. In the analysis, investigators examined 69 English-language plans to determine how they were developed, what they include, their usability, and their impact on clinical outcomes.

Common Management Strategies

The analysis identified several recurring components across the 69 plans. Most materials included breathing techniques, which appeared in 88% of the plans. Other common strategies included:

  • Positioning (78%)
  • Airflow strategies (65%)
  • Relaxation or distraction (36%)

Less common components identified by the researchers included stopping or slowing down, remaining calm, reassurance, support from others, and loosening clothing.

Quality and Usability Concerns

Although many plans are currently available for clinical use, their overall quality is mixed. Among the 48 plans that could be assessed using the Patient Education Materials Assessment Tool, the mean understandability score was 64%, and the mean actionability score was 68%.

The investigators also found that the median reading grade for these materials was 8.2. This suggests that some materials may remain too complex for certain segments of the target patient population.

Impact on Healthcare Utilization

Evidence supporting the efficacy of these plans remains limited, with the authors finding data from only one pre and post study. However, survey responses from patients and clinicians suggested the plans provide significant real-world value.

Among patients using a plan, 67% reported that the strategies helped them avoid calling an ambulance over the previous year. Clinician responses were also positive, with most perceiving that the plans improved patient confidence and reduced anxiety. Many clinicians also reported that the plans reduced the frequency of episodes, lowered the need for emergency department care, and supported activities of daily living.

The authors concluded that while breathlessness action plans appear promising, further research is needed to determine their effects on self-management, breathlessness outcomes, and healthcare utilization in the COPD population.

Reference:

Luckett T et al. Non-Pharmacological Breathlessness Action Plans for People with COPD and Their Support People: A Scoping Review and Survey of Current Practice. Int J Chron Obstruct Pulmon Dis. 2026;11:21:568299.

This article was originally published by EMJ and was made available under the terms of the Creative Commons Attribution-Non Commercial 4.0 License.