Breathlessness action plans in palliative care

Cambridge University Hospitals, 2022Rocker, 2013

Breathlessness action plans (‘crisis plans’) are personalised written action plansCambridge University Hospitals, 2022INSPIRE: breathing better that patients can refer to when breathlessness occurs. Breathlessness action plans are used widely for breathlessness associated with various conditions and can be particularly helpful for breathlessness associated with anxiety or panicBrighton, 2019Qian, 2018Reilly, 2016. The plan should incorporate nonpharmacological therapies that the patient finds helpful, and outline the role of pharmacological therapy (if appropriate). The NHS Breathlessness Intervention Service website and Inspire: breathing better website have breathlessness action plan templates available to download and print.

Note: Personalise written breathlessness action plans.

A simple action plan for breathlessness may include the 3Fs of recovery breathingCambridge University Hospitals, 2022:

  • ‘I am going to lean forward’.
  • ‘I am going to use my fan’.
  • ‘I am going to focus on long (or relaxed) breaths out’.

More detailed plans can have many steps, and vary depending on the underlying disease, pharmacological management, available support, and advance care plan.

Example of a breathlessness action plan is an example of a breathlessness action plan for advanced COPD that can be adapted for use in other conditions causing breathlessness in palliative care (eg advanced cancer, interstitial lung disease).

Provide breathlessness action plans in conjunction with disease-specific action plans to help patients manage exacerbations of the underlying disease. The COPD action plan can improve quality of life and decrease respiratory-related hospital admissionsLenferink, 2017. A COPD action plan template is available from the Lung Foundation Australia website.

Figure 1. Example of a breathlessness action plan. [NB1]

Stop where you are.

Try your recovery position.

Breathe slowly, for example imagine blowing out a candle.

Use your hand-held fan.

Repeat your mantra, for example ‘this will pass’.

Use relaxation strategies.

Use your puffer, for example ____ puffs of salbutamol with a spacer, and repeat at ___ minutes if breathlessness is not settling.

Adjust your oxygen flow from ___ to ___ litres/minute for ___ minutes, then re-adjust back to ____ litres/minute.

Use your morphine, for example ___ mg and repeat at ___ minutes if breathlessness is not settling.

Call ___ if breathlessness does not settle.

Note: NB1: This is an example of a breathlessness action plan for advanced COPD. Other examples (including printable templates) are available from the NHS Breathlessness Intervention Service website and the Inspire: breathing better website.