TABLE 2

BREATHE intervention and usual care

InterventionExamples of techniquesSupporting evidence
Be reassured#Reassure patient and carer; a reassuring and expert presence is sometimes sufficient to start “unwinding” escalating breathlessness[25, 26]
Resting positionCheck posture; find the most comfortable and efficient position to maximise ventilation[25, 27, 28]
Exercises (breathing)Use to slow breathing rate and encourage breathing out to prevent air trapping (e.g. pursed lip or “breathing rectangle”); pursed lip breathing also provides increased end-expiratory pressure[25–29]
AirflowUse hand-held fan; airflow across lower face/nasal passages can reduce breathlessness and recovery time[30–32]
Time#“Take it easy, nice and slow”#[25–27]
Help with fears and worries#Simple techniques to manage panic and fear#[25–27]
Education of patient and carerInformation booklet and laminated card with BREATHE intervention[25–28]
Intervention points:
  •  a) the techniques are often simultaneously delivered and tailored to the individual

  •  b) #: denotes anxiety-focused management

  •  c) The laminated BREATHE card, the information booklet and hand-held fan will be packaged in a “BREATHE folder” for paramedics to take into the house of a breathless patient.

Usual careJRCALC Guidelines [21]
 Immediate clinical assessmentHistory, baseline vital signs and targeted examination (e.g. chest auscultation, peak flow, 12-lead ECG)
 ReassuranceReassurance is a mainstay of high-quality patient care
 OxygenTime critical feature: oxygen saturations of <94% or less for those patients without chronic lung diseases
Target range oxygen saturation in patients with chronic lung diseases: 88–92%
If SpO2 >92%, oxygen would not be administered
 NebuliserDepending on the initial assessment, the paramedic may ask the patient to use their own inhalers, or proceed to nebulisation

JRCALC: Joint Royal Colleges Ambulance Liaison Committee; ECG: electrocardiogram; SpO2: oxygen saturation.