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Identification and assessment of breathlessness in clinical practice: a systematic review and narrative synthesis.

Elliott-Button, Helene; Johnson, Miriam J.; Nwulu, Ugochinyere; Clark, Joseph


Helene Elliott-Button

Ugochinyere Nwulu

Joseph Clark


Context: Breathlessness is common in chronic conditions but often goes unidentified by clinicians. It is important to understand how identification and assessment of breathlessness occurs across health care settings, to promote routine outcome assessment and access to treatment. Objective: The objective of this study was to summarize how breathlessness is identified and assessed in adults with chronic conditions across different health care settings. Methods: This is a systematic review and descriptive narrative synthesis (PROSPERO registration: CRD42018089782). Searches were conducted on Medline, PsycINFO, Cochrane Library, Embase, and CINAHL (2000–2018) and reference lists. Screening was conducted by two independent reviewers, with access to a third, against inclusion criteria. Data were extracted using a bespoke proforma. Results: Ninety-seven studies were included, conducted in primary care (n = 9), secondary care (n = 53), and specialist palliative care (n = 35). Twenty-five measures of identification and 41 measures of assessment of breathlessness were used. Primary and secondary care used a range of measures to assess breathlessness severity, cause, and impact for people with chronic obstructive pulmonary disease. Specialist palliative care used measures assessing broader symptom severity and function with less focus on overall quality of life. Few studies were identified from primary care. Conclusion: Various measures were identified, reflective of the setting's purpose. However, this highlights missed opportunities for breathlessness management across settings; primary care is particularly well placed to diagnose and support breathlessness. The chronic obstructive pulmonary disease approach (where symptoms and quality of life are part of disease management) could apply to other conditions. Better documentation of holistic patient-reported measures may drive service improvement in specialist palliative care.


Elliott-Button, H., Johnson, M. J., Nwulu, U., & Clark, J. (2020). Identification and assessment of breathlessness in clinical practice: a systematic review and narrative synthesis. Journal of pain and symptom management, 59(3), 724-733.e19.

Journal Article Type Review
Acceptance Date Oct 11, 2019
Online Publication Date Oct 23, 2019
Publication Date Mar 1, 2020
Deposit Date Oct 15, 2019
Publicly Available Date Oct 24, 2020
Journal Journal of Pain and Symptom Management
Print ISSN 0885-3924
Electronic ISSN 1873-6513
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 59
Issue 3
Pages 724-733.e19
Keywords Dyspnea; Breathlessness; Chronic breathlessness syndrome; Identification; Assessment; Patient reported outcome measures
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