TY - JOUR T1 - Treat the lungs, fool the brain and appease the mind: towards holistic care of patients who suffer from chronic respiratory diseases JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.00316-2018 VL - 51 IS - 2 SP - 1800316 AU - Thomas Similowski Y1 - 2018/02/01 UR - http://erj.ersjournals.com/content/51/2/1800316.abstract N2 - In healthy people, breathing is the most natural thing in the world. No need to think about it. No need to be concerned about it. It is not even the object of conscious perception. But when breathing becomes difficult, when it produces suffering, nothing else mattersa. Life discolours and shrinks around an act of breathing that has become elusive and uncertain, but pervasive. Disability ensues, which adds “a variety of adverse psychosocial, spiritual, or other consequences” to the respiratory-related physical limitations [1]. Respiratory suffering, be it called dyspnoea, breathlessness or by any other name, is therefore a major (and probably often the main) driver of impaired quality of life in patients afflicted with chronic respiratory diseases (and also cardiac diseases, neuromuscular diseases and severe obesity). To put things more bluntly, not being able to breathe freely is probably the worst thing that can happen to a human being. Dyspnoea has long been compared to pain [2] and has a lot of neurophysiological similarities with it [3, 4]. Yet in many ways dyspnoea is probably worse than pain. Indeed, acute dyspnoea goes hand in hand with fear, the fear of dying, which is not systematically the case with pain. And, not being a universal experience like pain, dyspnoea might be less susceptible than pain to induce reactions and empathy from those who witness it. Trained healthcare professionals dealing with respiratory distress on a daily basis fail to correctly evaluate the dyspnoea of their patients [5], and even though recent evidence suggests that vicarious dyspnoea does exist in a manner that resembles vicarious pain [6], the dyspnoea of chronic diseases tends to become invisible to caregivers [7]. This is perhaps because medical responses to dyspnoea are less codified and less efficient than responses to pain, but this phenomenon can only amplify the negative consequences of dyspnoea on the psychology of those experiencing it [7, 8]. Yet, as emphasised by Başoğlu [8] in a recent editorial, failure to enquire about, assess and properly treat breathlessness as outlined in specialist clinical guidelines is a breach of clinicians' ethical and legal duties to patients (see also [9]). On top of this clinical importance, respiratory suffering is the point of convergence and the final pathway of an array of diseases that at times have little in common and of which the specialists can have trouble understanding each other. In other words, dyspnoea is the “unifier” of respiratory medicine with all its diversity. For all these reasons, dyspnoea should be a foremost concern for all healthcare professionals, a primary criterion in clinical research, and the focus of specific multidisciplinary research efforts. Fortunately there are indications that this is becoming the case worldwide, and the European Respiratory Society (ERS) plays a significant role in this movement as attested to by a number of publications of all types in the European Respiratory Journal [1, 8, 10–14] and the European Respiratory Monograph series [15], and the endorsement by the ERS of the Dyspnea 2016 meeting organised by the International Dyspnea Society (www.dyspnea2016inparis.fr/sponsors/endorsement).Mindfulness-based cognitive therapy can improve well-being in COPD patients beyond usual therapeutic measures: this is additional evidence for a holistic approach to chronic breathlessness http://ow.ly/Dz2630irqvRThe author is grateful to Miriam J. Johnson for her critical appraisal of the manuscript and her help improving it. ER -