A multidisciplinary, non-pharmacologic intervention improves breathlessness in COPD: An RCT.

<bold>Introduction:</bold> COPD is a common, often progressive, disease, associated with disabling breathlessness. Breathlessness intervention services(BIS) are effective in mixed populations but efficacy in COPD is unclear. <bold>Aim:</bold> To assess the effect of the Westmead BIS on breathlessness mastery in people with advanced COPD. <bold>Methods:</bold> We randomised 113 participants(1:1) with moderately severe/severe COPD(FEV1/FVC<0.70 and FEV1≤60% predicted) and disabling breathlessness(mMRC≥2) to an 8-week non-pharmacological, multidisciplinary intervention(n=54) or 8-week wait-list control group(n=59). Primary outcome: change in Chronic Respiratory Questionnaire(CRQ) breathlessness mastery. Secondary outcomes: CRQ subscales; exertional breathlessness intensity/ unpleasantness(0-10 Numerical Rating Scale). Data presented as mean(SD) or median(IQR). Groups compared using ANOVA. P<0.05 was significant. <bold>Results:</bold> Participants were aged 70.9(8.5) years, 50% female, mean FEV1 0.84L(0.34L; 34% predicted), mMRC score 3(3-4). Improvement in CRQ breathlessness Mastery was significantly greater following intervention compared with control (difference 0.4 au; CI:0.1,0.7; p=0.015). CRQ Dyspnoea (difference 0.4au; CI:0.1,0.7; p=0.015) and CRQ Fatigue (difference 0.4au; CI:0.1,0.7; p=0.005) improvements were also greater. Exertional breathlessness unpleasantness decreased (difference -1.1au; CI:-1.8, -0.3; p=0.005), but not breathlessness intensity (difference -0.7au; CI:-1.3, 0.0; p=0.059). <bold>Conclusion:</bold> An 8-week non-pharmacological intervention improves breathlessness mastery, dyspnoea and fatigue compared with standard care in people with advanced COPD. This provides evidence to utilise BIS to improve symptoms in this COPD population.