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Strategies for patients who become breathless at night

Strategies for patients who become breathless at night. Kevin Taylor, Integrated Respiratory Team Leader Jane Hutton, Consultant Clinical Psychologist. Expectations. Your Expectations?. Our Expectations Review good practice for getting a nights sleep.

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Strategies for patients who become breathless at night

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  1. Strategies for patients who become breathless at night Kevin Taylor, Integrated Respiratory Team Leader Jane Hutton, Consultant Clinical Psychologist

  2. Expectations • Your Expectations? • Our Expectations • Review good practice for getting a nights sleep. • Update on physiological reasons for symptoms. • Dispel some myths. • Identify warning signs. • Who else can help?

  3. Respiratory Disease • COPD – Main respiratory disease causing night time breathlessness • Other long term conditions affecting breathing at night • Asthma? • Obstructive Sleep Apnoea • Obesity Hypoventilation • Heart Failure

  4. Causes of breathlessness at night? • Nothing specific about night. • Deteriorating day time symptoms • Breathlessness • Sputum clearance • Anxiety • Early signs of exacerbation? • Worsening breathlessness >24 hours • Increased sputum from normal levels • Change in colour of sputum • Increased wheeze • Call Integrated Respiratory Team for advice: • STH: 07796178719 • KCH: 07528977597

  5. COPD Treatments for Breathlessness?

  6. Smoking Cessation • By far the most beneficial treatment for breathlessness in COPD. • Range of options to support.

  7. Pulmonary Rehabilitation • Most effective treatment for improving breathlessness after smoking cessation. • Progressive rehabilitation over a course of 6-12 weeks, followed by maintenance physical activity. • http://www.nhs.uk/Video/Pages/Pulmonaryrehabilitation.aspx • Rieset al., Annals of Internal Medicine 1995, 122 (11) : 823-31.

  8. Medications If Technique is good! • Beta-2 Agonists • Salbutamol OR No difference: Cates et al., 2003 Cochrane review

  9. What suits the patient more? • Noise • Speed of delivery • Handling of devices • Side effects • 20 mins to effect • 2 hours duration of effect. • Any long acting agents?

  10. Timing of inhaled therapies • Long acting agents • Tiotropium • Short acting • Salbutamol half life 2.7-5.5 hours • Sharp ramp up and down.

  11. Positioning • Principles of physiology • Fixing upper limbs enables accessory muscle efficiency. • Can lead to fatigue. • Sitting up in bed or side lying • Pillows under arms.

  12. Other LTCs • Asthma • More likely cough at night than Breathlessness • Medical review • Obstructive Sleep Apnoea • Specialist assessment • Obesity Hypoventilation • Specialist assessment • Heart Failure • Sitting up in bed • Community Heart Failure team review

  13. Further input • Coughing up blood • Chest pain at night • Palpitations • Cyanosis • Neurological change

  14. Breathlessness is not dangerous • Common, understandable misconception • Avoiding exertion leads to maintenance of fears, reduced fitness and low mood • Heightened attention and catastrophic misinterpretations, especially fear of death • Not desirable to avoid breathlessness entirely • Keeping active and confident will entail some • Can be challenged in pulmonary rehab • Involving family members

  15. Key principles • Helping patients to understand condition and treatment • Identifying and addressing beliefs and fears • Proactive strategies • Practice and confidence • Sleep routine

  16. Key components of booklet • Hope for change • Understanding mind-body model • Thoughts can be very frightening but untrue • New ways of responding to thoughts • Distraction, grounding and breathing for relaxation • Reducing stress and increasing activity • Enlisting appropriate help

  17. Improving Access to Psychological Therapies • Stepped care • Focus on long-term medical conditions • Pathfinder project in Southwark and elsewhere • Southwark 020 3228 2194 • Lambeth 0203 228 6747

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