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• W2912902844 abstract "Lovell et al. are to be commended for their description of the widespread effects of breathlessness within the construct “total breathlessness”.1Abernethy A.P. Wheeler J.L. Total dyspnoea.Curr Opin Support Palliat Care. 2008; 2: 110-113Crossref PubMed Scopus (62) Google Scholar Despite the large body of evidence on the experience of people living with chronic breathlessness, clinicians still struggle with its recognition and assessment. Even when recognized, the symptom is undertreated2Ahmadi Z. Sandberg J. Shannon-Honson A. Vandersman Z. Currow D.C. Ekström M. Is chronic breathlessness less recognised and treated compared with chronic pain? A case-based randomised controlled trial.Eur Respir J. 2018; 52: 1800887Google Scholar and is experienced by people over many years3Johnson M.J. Bowden J.A. Abernethy A.P. Currow D.C. To what causes do people attribute their chronic breathlessness? A population survey.J Palliat Med. 2012; 15: 744-750Crossref PubMed Scopus (34) Google Scholar, 4Currow D.C. Dal Grande E. Ferreira D. Johnson M.J. McCaffrey N. Ekström M. Chronic breathlessness associated with poorer physical and mental health-related quality of life (SF-12) across all adult age groups.Thorax. 2017; 72: 1151-1153Crossref PubMed Scopus (46) Google Scholar, 5Hutchinson A. Pickering A. Williams P. Bland J.M. Johnson M.J. Breathlessness and presentation to the emergency department: a survey and clinical record review.BMC Pulm Med. 2017; 17: 53Crossref PubMed Scopus (59) Google Scholar and is associated with repeated unplanned presentations to health services.6Nunez S. Hexdall A. Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors?.Qual Saf Health Care. 2006; 15: 102-108Crossref PubMed Scopus (113) Google Scholar In our prospective observational study of 1212 patients presenting to the emergency department by ambulance,5Hutchinson A. Pickering A. Williams P. Bland J.M. Johnson M.J. Breathlessness and presentation to the emergency department: a survey and clinical record review.BMC Pulm Med. 2017; 17: 53Crossref PubMed Scopus (59) Google Scholar 20% presented due to acute-on-chronic breathlessness (acute worsening of chronic breathlessness). The concept of acute-on-chronic breathlessness builds on the definition of chronic breathlessness syndrome7Johnson M. Yorke J. Hansen-Flaschen J. Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness.Eur Respir J. 2017; 49Crossref Scopus (154) Google Scholar and mirrors concepts of disease (acute-on-chronic renal failure) or symptoms (acute-on-chronic pain). Acute-on-chronic breathlessness is a construct beyond the “dyspnea crisis,” which is limited in its definition to late-stage disease8Mularski R.A. Reinke L.F. Carrieri-Kohlman V. et al.An official American Thoracic Society workshop report: assessment and palliative management of dyspnea crisis.Ann Am Thorac Soc. 2013; 10: S98-S106Crossref PubMed Scopus (74) Google Scholar and encompasses all forms of episodic breathlessness, triggered or untriggered.9Simon S.T. Higginson I.J. Benalia H. et al.Episodes of breathlessness: Types and patterns–a qualitative study exploring experiences of patients with advanced diseases.Palliat Med. 2013; 27: 524-532Crossref PubMed Scopus (41) Google Scholar In our emergency department study, one-third of people with acute-on-chronic breathlessness were discharged home but without evidence of a plan to manage the ongoing chronic breathlessness. Unless clinicians (in any setting) recognize both the acute and chronic aspects of acute-on-chronic breathlessness, the life experience of chronic breathlessness remains invisible, which denies the patient access to evidence-based interventions10Ekström M. Bajwah S. Bland J.M. Currow D.C. Hussain J. Johnson M.J. One evidence base; three stories: do opioids relieve chronic breathlessness?.Thorax. 2018; 73: 88-90Crossref PubMed Scopus (74) Google Scholar, 11Bausewein C. Schunk M. Schumacher P. Dittmer J. Bolzani A. Booth S. Breathlessness services as a new model of support for patients with respiratory disease.Chronic Respir Dis. 2018; 15: 48-59Google Scholar and misses opportunities to lessen the likelihood of re-presentations.6Nunez S. Hexdall A. Aguirre-Jaime A. Unscheduled returns to the emergency department: an outcome of medical errors?.Qual Saf Health Care. 2006; 15: 102-108Crossref PubMed Scopus (113) Google Scholar Community clinicians struggle with how to identify, assess, and manage chronic breathlessness. There are now useful frameworks to guide clinicians' assessment12Hopkinson N.S. Baxter N. Breathing SPACE—a practical approach to the breathless patient.NPJ Prim Care Respir Med. 2017; 27: 5Crossref PubMed Scopus (17) Google Scholar and management.13Spathis A. Booth S. Moffat C. et al.The Breathing, Thinking, Functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease.NPJ Prim Care Respir Med. 2017; 27: 27Crossref PubMed Scopus (85) Google Scholar As described in the Breathing Space concept,14Hutchinson A. Barclay-Klingle N. Galvin K. Johnson M.J. Living with breathlessness: a systematic literature review and qualitative synthesis.Eur Respir J. 2018; 51: 1701477Crossref PubMed Scopus (84) Google Scholar the clinician plays a pivotal role in recognizing background chronic breathlessness—a step often overlooked. Defining chronic breathlessness syndrome7Johnson M. Yorke J. Hansen-Flaschen J. Towards an expert consensus to delineate a clinical syndrome of chronic breathlessness.Eur Respir J. 2017; 49Crossref Scopus (154) Google Scholar has been an important first step. There is a new imperative: if a patient presents with acute breathlessness, there is now a responsibility for clinicians to determine whether this is an isolated episode of acute breathlessness or a presentation of acute-on-chronic breathlessness." @default.
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• W2912902844 title "Acute-on-Chronic Breathlessness: Recognition and Response" @default.
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