Management of chronic breathlessness: a multinational survey of respiratory medicine and palliative care doctors

Background: Breathlessness management appears to differ between clinical specialties, but data are limited. Aims and Objectives: To explore breathlessness management by respiratory medicine (RM) and palliative care (PC) doctors, and the influence of guidelines. Methods: European RM and PC doctors were invited to complete an online survey that included 3 case vignettes: advanced COPD; fibrotic ILD; lung cancer (LC). Respondents indicated preferred management on Likert scales. We compared RM and PC responses, and if management varied with knowledge of guidelines. Results: 348 RM and 102 PC provided complete responses. PC doctors prioritised drug treatment regardless of diagnosis, but RM doctors prioritised drug treatment for breathlessness in LC, preferring physical activity and rehabilitation in other settings. Thus, more PC than RM doctors often or always use opioids in COPD (92% vs. 39%), ILD (83% vs. 36%) and LC (95% vs. 76%) (p Conclusions: Breathlessness management varies between specialties, and is influenced by knowledge of guidelines. There is a need for international interdisciplinary practice guidelines for the management of breathlessness in advanced respiratory disease. Funding: EU Horizon2020 grant #825319