Better Treatments for Refractory Breathlessness
Chronic breathlessness is a distressing and highly prevalent symptom of advanced chronic respiratory diseases. It is associated with social isolation, high healthcare costs and poor prognosis. Currently, there are few effective drug treatments thus, chronic breathlessness represents a huge unmet need.
At the core of the Better Treatments for Refractory Breathlessness project (BETTER-B) is an international, multicentre, randomised controlled trial testing the effectiveness of mirtazapine, an established antidepressant, in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).
The BETTER-B programme of work also includes an online survey of physicians to understand current clinical management of breathlessness, the production of European wide guidance on the management of breathlessness in palliative and end of life care, and qualitative interviews with trial participants (patients and caregivers) to further understand their experiences.
Aims
To deliver a step-change in the evidence-based management of breathlessness in palliative and end of life care.
Methods
The BETTER-B investigators have conducted a randomized, double-blind, clinical trial in order to test the efficacy and cost-effectiveness of mirtazapine compared to a dummy drug in patients located in the UK, several European countries, Australia and New Zealand. The project also included an online survey, the production of a Europe-wide guide on the management of breathlessness in palliative and end-of-life care, and interviews with trial participants to understand their experiences.
Summary of Findings
From the BETTER-B online survey, we found wide variations in how breathlessness is managed. People are receiving different levels of care based on where they are treated and the disease that they have. Some people may be seen by respiratory physicians, while others may be treated by palliative care physicians. Of those that responded, a sizeable number of respiratory and palliative care physicians often or always recommended antidepressants for patients with advanced respiratory diseases, even where there was no evidence of depression. This finding demonstrates the need for proper assessment of medicines.
We enrolled 225 patients and 75 caregivers across the UK, Europe, Australia and New Zealand into the trial. The project has engaged with patient-led groups and clinicians across the countries. The trial findings and Europe-wide guide are due to be published soon.
Impact
BETTER-B provides a wide-reaching impact by translating the trial and research results to produce recommendations, educational materials and clinical improvements for clinicians and policymakers in palliative, supportive, respiratory, primary and end-of-life care.
Some resources developed by our King's team that you may find helpful in breathlessness management are listed below:
Breathlessness Support Service Toolkit
- Patient education and advice about breathlessness
- Managing breathlessness
- Hand-held fan
- Positional techniques
- Distraction techniques
- Sleep hygiene
- Breathlessness poem
Free e-resources for professionals
For further information on managing breathlessness in advanced illness, please read the feature article 'Managing breathlessness in advanced illness'.
Our Partners
University College Dublin
The University of Leeds Clinical Trials Research Unit
University of Nottingham
Trinity College Dublin
Principal Investigator
Director of Better Health and Care Futures
Investigators
Professor of Health Services Research & Rehabilitation
Clinical Senior Lecturer and Honorary Consultant in Palliative Care
Professor of Economics of Palliative Care & Rehabilitation
Affiliations
Project websites
Funding
Funding Body: European Commission
Amount: €3.7million
Period: January 2019 - June 2023