Desktop Helper 3 - Table 3. Non-pharmacological interventions to address breathlessness and exercise capacity

27 Apr 2022
Respiratory conditions
  • COPD
Respiratory topics
  • Disease management
  • End of Life
Type of resource

Table 3. Non-pharmacological interventions to address breathlessness and exercise capacity



Supporting references

Pulmonary rehabilitation

Can relieve breathlessness and fatigue, improves emotional state and enhances person’s sense of control over their condition – moderately large and clinically significant improvements

McCarthy B, et al. 2015

Facial cooling with a fan or cool flannel.

See this video

Good evidence of short-term benefit from using a fan (static or hand held), relieving breathlessness at rest and reducing recovery time after activity. Movement of air over a person’s face is thought to stimulate a vagal response

A cool flannel is an alternative

Yu S, et al. 2019

Qian Y, et al. 2019

Swan F, et al. 2019

Luckett T, et al. 2017



20-minute mindful breathing reduces breathlessness in lung disease, and anxiety/depression in advanced disease; enhances non-evaluative attention and may increase self-efficacy

Seetee S, et al. 2016

Malpass A, et al. 2018

Tan SB, et al. 2019

Look ML, et al. 2021

Relaxation techniques

Some evidence can help anxiety, breathlessness and fatigue in COPD. Guided imagery (‘thinking of a nice place’), progressive muscular relaxation and counting are most acceptable

Hyland ME, et al. 2016

Kutmex Yilmaz C, Kapucu S. 2017

Volpato E, et al. 2015


May help breathlessness as a component of an evidence-based complex intervention

Brighton LJ, et al. 2019

Walking aids

Can improve exercise capacity

Vaes AW, et al. 2015

Cognitive behavioural therapy

Problem-solving approach that challenges unhelpful thoughts/ behaviours; reduces anxiety in COPD in short term; increases pulmonary rehabilitation attendance

Yohannes AM, et al. 2017

Heslop-Marshall K, et al. 2018

Pumar MI, et al. 2019

Breathing techniques

Most studies do not find this intervention improves breathlessness, although some evidence in lung cancer and pursed lip breathing may help in COPD; however, these are a key component of evidence-based complex interventions for breathlessness

Borge CR, et al. 2014

Ubolnuar N, et al. 2019

Liu X, et al. 2019

Brighton LJ, et al. 2019



Improves breathlessness in advanced disease and may reduce anxiety

Von Trott P, et al. 2020

Inspiratory muscle training

Conflicting evidence for impact on breathlessness; people need to be carefully selected

Langer D, et al. 2018

Beaumont M, et al. 2018





What is pulmonary rehabilitation?


“A comprehensive intervention based on thorough patient assessment followed by patient-tailored therapies that include, but are not limited to, exercise training, education, self-management intervention aiming at behaviour change, designed to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long-term adherence to health-enhancing behaviors.”

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