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COPD – Reduced feeling of breathlessness

Reduced feeling of breathlessness

Evidence summary

A large body of interventional data shows a reduction in dyspnoea symptoms as measured by outcome scores.

Quality of evidence

Moderate quality – evidence comes from randomised controlled trials

Strength of recommendation

Strong – clinical and participant consensus is that physical activity can reduce the dyspnoea symptoms.

Selected References

Pan, et al. (2012)34

Meta-analysis, 7 studies,240 patients, examining whether unsupported upper limb exercise reduces dyspnoea and arm fatigue.

ADL dyspnoea reduced (WMD=-0.58; 95% CI = -1.13 to -0.02), however the overall treatment effects were lower than the MCID of 1 unit for the Borg scale.

Arnardottir (Respiratory Medicine, 2007)35

Continuous vs Interval Training (16 weeks, twice weekly) – 60 participants

Dyspnoea: CRDQ – improved 2.7/3.7 points

Nasis (Respiratory Medicine, 2009)38

Continuous vs Interval Training (3x weekly 10 weeks), 42 participants

Dyspnoea: change in MMRC 0.4

Santos (Respiratory Care, 2015)40

HIT vs LIT (3x weekly 8 weeks), 34 participants

Dyspnoea: change in Mahler’s dyspnoea index: 3/3.5

Zwerink (Respiratory Medicine, 2014)42

Outcomes other than physical activity: Maximal exercise capacity, CRQ (chronic respiratory questionnaire) score has dyspnoea, fatigue, emotional function and mastery domains, CCQ (clinical COPD questionnaire) score, HADS (hospital anxiety and depression score)

11-month community based physiotherapy-led exercise programme + 4 self-management sessions  vs 4 self-management sessions only, 12 and 24 month follow-up. Specific outcomes (i.e. p value and absolute change and size of study). 80 patient intervention group, 79 control group. Improved CRQ dyspnoea domain only.