Table 1 The Breathing SPACE framework
From: Breathing SPACE—a practical approach to the breathless patient
Smoking cessation | Ask about smoking, advise to quit, offer assistance to quit. Adopt the CO4 approach7: |
1. The right COnversation, with every patient and staff member who smokes, that gives them a chance to quit, referring for support if necessary | |
2. Offer routine exhaled carbon monoxide (CO) monitoring: “Would you like to know your level?” | |
3. COde smoking cessation interventions and include smoking history in death certification | |
4. COmmission services where smoking cessation behaviours are incentivised systematically | |
Pulmonary disease | Ask about symptoms—cough, sputum, variability, nocturnal symptoms, chest discomfort, haemoptysis |
Investigations—rapid access to quality assured spirometry | |
Pulse oximetry | |
Prioritise high-value interventions—smoking cessation, pulmonary rehabilitation, flu vaccination | |
Ensure that inhaled medications are both prescribed and used appropriately | |
Anxiety | Psychosocial factors contribute to symptoms in cardiorespiratory disease. Anxiety may present with specific features of hyperventilation/dysfunctional breathing syndrome, including paraesthesia and “air hunger” |
Parity of esteem—address the physical health of people with mental health issues | |
Smoking cessation interventions are effective and safe to use in people with mental health problems | |
Peer support, e.g., BLF Breathe Easy groups | |
Cardiac disease | Ask about risk factors (smoking, hypertension, diabetes, ischaemic heart disease?) |
Abnormal pulse, pulmonary crepitations, oedema, cardiac murmurs | |
Cardiac complications of respiratory disease—pulmonary hypertension, sleep-disordered breathing | |
Investigations—consider ECG, BNP, echocardiogram | |
Refer patients with heart disease who feel limited by their symptoms for exercise rehabilitation | |
Exercise level and | Ask about exercise level “Do you take any regular exercise?” |
fitness | Give brief advice to increase physical activity levels8 |
Reassure and encourage: “It’s not harmful to make yourself breathless” | |
Refer patients with lung or heart disease who feel limited by their symptoms for exercise rehabilitation | |
Obesity—identify this explicitly as a contributor to breathlessness | |
Signpost opportunities to participate in exercise (e.g., Park Run, Couch to 5K). Pedometer-based interventions with a step count goal are effective9,10 |
