“BREATHE”: an educational approach for optimising the management of chronic respiratory diseases in primary care

Introduction/Aim Optimisation of underlying chronic respiratory disease (CRD) is a necessary first step to addressing breathlessness. We aimed to develop and evaluate a disease-agnostic education package and mnemonic to support primary care providers to recognise breathlessness and facilitate optimisation of underlying CRD. Methods A blended education package comprising one live webinar, three self-paced online courses, two podcasts, and five case-studies was developed by a working group of general practitioners (GPs), respiratory clinicians and researchers and adapted into a practical mnemonic (the BREATHE clinical approach). Content was validated against a systematic state-of-the-art review of international and national guidelines. Semi-structured interviews with GPs, general practice nurses and a practice manager were conducted to evaluate the educational content and design. Interviews were transcribed and analysed thematically with inductive coding. Results Five disease-agnostic recommendations were developed and validated against 33 clinical practice documents: B reathlessness (measure severity); R espiratory illness (confirm diagnosis); E xtra illnesses (consider other causes of breathlessness); A dherence (check medication use and technique); T obacco (discuss smoking cessation); H elp (consider referral to specialist services); E xercise (consider pulmonary rehabilitation). Thirteen interviews were conducted (8 GPs; 4 nurses; 1 practice manager); this showed the BREATHE educational package and clinical approach to be acceptable. Time constraints were frequently cited as a barrier to education engagement, with flexible education preferred. Respondents described the BREATHE clinical approach as a comprehensive tool that would enable clinicians to “remember the specifics” , whilst highlighting the need for multiple consultations to address all elements of care. Conclusion The BREATHE clinical approach and education package were favourably received as useful tools to support primary care providers to optimise treatment for people with CRD.