End of life care

Management of pain and other distressing symptoms is a key part of end of life care and physiotherapy, as with other patient groups, has a key role to play. For example coping with breathlessness, especially when acute may be one of the most difficult symptoms health professionals face when caring for patients at the end of life. Physical and emotional distress are inextricably interwoven. Whilst medication may alleviate such symptoms, side effects such as respiratory depression, constipation or excessive drowsiness may add to difficulties. Breathing control techniques taught by physiotherapists are an effective alternative in managing breathlessness and may enable the patient to pace their own breathing and regain some control and retain the ability to perform everyday basic activities of living for as long as possible.

Case study - non-pharmacological management of breathlessness

Research indicates that maintaining a sense of control while living with a long-term condition and facing the end of life is important, particularly during the very late stages. In such situations individuals usually respond positively to simple well-taught self-help measures such as breathing control and relaxation. Breathing control and relaxation techniques are core skills of the physiotherapist and often form part of the management strategies employed in helping individuals with chronic obstructive pulmonary disease (COPD), asthma and other respiratory diseases to maintain independence in self caring for as long as possible.

The physiotherapy department at a hospice has identified a far greater significance for patients using breathing control techniques in the management of anxiety and panic attacks. Research suggests that breathing control coupled with behavioural management strategies is very successful in reducing the perception of breathlessness and enhancing perceptions of control, enabling greater sense of wellbeing in the later stages of illness.