Background Chronic breathlessness is common in cardiorespiratory conditions and is frequently associated with emergency department (ED) presentation when the patient experiences acute-on-chronic breathlessness. Breathing Space is a concept combining patient coping, help-seeking and clinician responsiveness to breathlessness in addition to disease-management. This study aimed to explore whether Breathing Space may help explain the decision by patients with acute-on-chronic breathlessness to present to the ED.

Methods Secondary mixed-methods analysis of patient self-report survey, case note and interview data. We used an in-depth case-history approach to synthesise these source data from eight representative patients who presented to the ED due to acute-on-chronic breathlessness. Patient-interview data were also linked with interview data from their family carers and clinicians.

Results Secondary analysis of eight survey and case note reviews, combined with analysis of eight patient interviews (four with a carer) and six clinician interviews was conducted. The Breathing Space concept was useful in understanding the individual patient’s decision to attend the ED. Having a clinician who both understands the impact of breathlessness on their patient and offers ways of managing breathlessness in addition to treating the underlying disease seems to be important. Clinicians responsive to breathlessness were able to encourage a disengaged patient (with restricted Breathing Space) to move towards a more adaptive way of living with breathlessness (greater Breathing Space). The converse was seen when clinicians had a sole focus on disease-directed treatment.

Conclusion The Breathing Space concept may be useful for clinicians caring for people with chronic breathlessness. Early assessment and management of the Breathing Space of the patient (and carer) may help improve the patient’s (and carer’s) quality of life and the management of acute-on-chronic breathlessness crisis.