Service planning and delivery for chronic adult breathlessness

The diagnosis and management of the symptom and underlying causes of chronic breathlessness challenge current health service organisation and delivery, as evidenced by late diagnosis or misdiagnosis, underuse of effective treatments and resource waste in times of health service austerity. A new approach that builds on the evidence and experience of managing complexity in healthcare is needed. This chapter summarises where we are now in terms of the scope and scale of the problem and offers some options to tackle it. It describes how to improve diagnosis and treatment in all settings by using a decision support tool derived from multidisciplinary case-based discussion and the literature on heart failure, COPD, asthma, obesity and anxiety interventions. It also describes how to set up specific cardiorespiratory services, and how to extend the learning from the best palliative care services for breathless patients. For the longer term, it offers the vision of a population-based approach, describing aims, objectives and criteria to evaluate the impact of a breathlessness system.