Evidence-based intervention for chronic refractory breathlessness: practical therapies that make a difference.

British Journal of General Practice, November 2013 609 IntroduCtIon Chronic breathlessness which is refractory to treatments for the underlying condition is a common symptom of frequently encountered conditions that present in primary care, including lung and heart disease, and cancer. Primary-care based chronic illness initiatives such as clinics for asthma or chronic obstructive pulmonary disease (COPD) and community heart nurse specialists play a vital role in optimising the management of the underlying condition(s), but for many people, especially in the later stages of the disease, breathlessness persists (chronic refractory breathlessness). Chronic refractory breathlessness is distressing for patients, their families and other caregivers, and for clinicians. Clinically, chronic refractory breathlessness is a distinct entity, rather than simply a failure to treat the underlying condition(s). It requires a different approach than that required for acute breathlessness brought on, for example, by acute coronary syndrome, an acute exacerbation of COPD, or acute pneumonia.