Illness perceptions, cognitive and behavioural responses to chronic breathlessness in individuals living with advanced respiratory disease: an observational study

Understanding the complexity and multidimensional nature of chronic breathlessness is key to its successful management. The aim of this study was to explore illness perceptions, cognitive and behavioural responses to chronic breathlessness in individuals living with advanced respiratory disease.A cross-sectional secondary analysis of data from a feasibility randomised control trial of SELF-BREATHE for individuals living with chronic breathlessness due to advanced disease. All participants completed the following questionnaires: Numerical rating scale (NRS) breathlessness severity, NRS distress due to breathlessness, NRS self-efficacy for managing breathlessness, Dyspnoea 12, chronic respiratory disease questionnaire (CRQ), brief illness perception questionnaire (brief IPQ) and the cognitive and behavioural response questionnaire short version (CBRQ-S). The associations between the brief IPQ, CBRQ-S, NRS breathlessness severity, distress and self-efficacy, D-12 and CRQ were examined using Spearman's rho correlation coefficients. A Spearman's rho of≥0.50 was pre-defined as the threshold to denote important associations between variables. A p value <0.008 was considered statistically significant, to account for the number of comparisons performed.Illness perception items: consequences, identity, concern, and emotional response were associated with increased breathlessness severity, increased distress, reduced breathlessness self-management ability and lower health related quality of life. Symptom focusing and embarrassment avoidance were identified as important cognitive responses to chronic breathlessness.Interventions that directly target illness perceptions, cognitive and behavioural responses to chronic breathlessness may improve symptom burden, self-efficacy, and health-related quality of life.