Breathlessness is common in people with heart and lung problems.
It can get very severe and frightening at times and it is a common reason for patients or family members to call an ambulance. In an earlier study, we found that one in five people taken by ambulance to Accident and Emergency (A&E) called for help because of breathlessness, but a third of these settled quickly and did not need to stay in hospital. It may be that some patients do not need to go to the A&E for their breathlessness, but can be helped by paramedics in their own homes instead.
We want to test this idea, but before we can do that we need to find out more about how best to do a full study, including how best to approach patients to join the study, how to collect information and whether or not the ways paramedics helped them with their breathlessness seemed all right to patients, carers and paramedics. So, in this study (Breathlessness RElief AT HomE or BREATHE), we trained paramedics in ways to ease breathlessness. We then asked if patients and paramedics thought this was useful. We also explored the best way to run a larger study to see if this was better than how paramedics usually care for these patients.
Twenty-nine paramedics in Yorkshire were chosen by chance to use ways to ease breathlessness with patients or to care for them as they usually would. We noted how quickly patients’ breathing eased and whether or not they were taken to A&E. We aimed to find sixty patients to take part in this study, but because the pandemic placed great pressure on ambulance services and also fewer patients with long-term breathlessness made 999 calls, only thirteen patients joined the study.
However, from this study, we now know that patients, carers and paramedics find these ways to ease breathlessness helpful and that it was safe and took no longer than what paramedics usually do. We also know that paramedics can collect study information from breathless patients at a call-out, and we have learned a lot about the best way to run a future, larger study. We still need to do some more work before we can run the larger study, such as involving many more paramedics in the study so that they can find as many patients as possible to join it. We also need to alter the way information is collected by the paramedics and rework the paramedic training materials.
Two patients with breathlessness, two carers and an Asthma + Lung UK representative were involved throughout the study. We have presented our findings at the 999EMS Research Forum Conference, the European Association for Palliative Care Research Congress and Dyspnea 2022 and have published our study in ERJ Open Research. The next step is to run a further, larger study with improvements based on what we have found in this feasibility study.
Breathlessness RElief AT HomE (BREATHE) is a collaboration between Hull York Medical School, the Yorkshire Ambulance Service, the University of York and the University of Sheffield with support from Asthma + Lung UK. The development of the application was supported by funding from NHS Hull CCG and the Alumni of the University of Hull.
Publications
- Blog post: Road paramedic to recruiting research paramedic - College of Paramedics, 12 December 2022
- Mixed-methods feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): Study findings. Ann Hutchinson, Victoria Allgar, Judith Cohen, David C. Currow, Susan Griffin, Simon Hart, Kelly Hird, Andrew Hodge, Suzanne Mason, Matthew Northgraves, Joanne Reeve, Flavia Swan, Miriam J. Johnson. ERJ Open Research Jan 2022, 00257-2022.
- Northgraves M, Cohen J, Allgar V, et al. A feasibility cluster randomised controlled trial of a paramedic-administered breathlessness management intervention for acute-on-chronic breathlessness (BREATHE): Study protocol. ERJ Open Res 2021; in press.