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97 How do physicians in South India recognise, assess and manage chronic breathlessness and is chronic breathlessness considered a syndrome or diagnosis?
  1. Matilda MM Barnes-Harris,
  2. Miriam J Johnson,
  3. Sunitha Daniel and
  4. Venkateswaran Chitra
  1. Hull York Medical School, Wolfson Palliative Care Research Centre, University of Hull, Amrita Institute of Medical Sciences Amrita University


Background Chronic breathlessness syndrome has been recently defined to help clinicians actively seek and patients legitimately present with persistent breathlessness, and to drive service development and research. There are many evidence-based interventions emerging. However, the naming and defining process did not include views from low to middle-income countries, where chronic breathlessness is a significant issue.

Methods Views of hospital physicians caring for people with conditions causing chronic breathlessness were explored in a South Indian hospital as part of a service improvement project. Three semi-structured focus groups were conducted in English, audio-recorded, transcribed and subjected to thematic analysis.

Results Fifteen clinicians participated, representing oncology, palliative care, cardiology and respiratory specialties. Three major themes (Impact, Invisibility and Purpose) and 12 subthemes were generated by the data.

Chronic breathlessness as defined, was seen as prevalent with a huge impact on patients, their families, carers and clinicians. In non-palliative care clinicians, a sense of therapeutic helplessness with a lack of awareness or ability to manage chronic breathlessness was observed in association with active avoidance. This, a perceived lack of assessment tools and lack of clear clinical pathways allowing access to palliative care contributed to the invisibility of people with this symptom.

Most participants were in agreement about the name of chronic breathlessness syndrome. All agreed that focussed systematic identification would foster education regarding assessment, management and monitoring and would support service development and research.

Conclusions Chronic breathlessness syndrome is recognised in clinical practice in Southern India but risks being invisible due to lack of awareness, particularly of interventions to manage the breathlessness itself. A named and defined syndrome was seen as a way to improve identification and management of chronic breathlessness.

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