chronic disease, chronic obstructive pulmonary disease, dyspnea, pursed-lips breathing, symptom management, telehealth



  1. Mark, Debra D. PhD, RN
  2. Ikehara, Curtis MPH, PhD
  3. Matsuura, Christine MS, ACNS-BC, APRN-Rx
  4. Hara, Kris RRT
  5. Li, Dongmei MS, PhD


Providing palliative care to persons with diseases other than cancer is challenged by the need to determine the trajectory for death. Persons with chronic disease, including cancer, require the same care directed at symptom management, optimization of quality of life, advanced care planning, and caregiver support. Chronic obstructive pulmonary disease is projected to be the third leading cause of death by 2030, with dyspnea being the most frequently reported symptom. Pursed-lips breathing (PLB) is a self-management technique that relieves shortness of breath by decreasing hyperinflation, thereby potentially improving activity tolerance.


This feasibility study measured the effect of PLB training delivered over Skype on dyspnea, physical activity, health-related quality of life, and self-efficacy. The intervention was found to be feasible and demonstrated marginal improvements in quality-of-life measures. However, when controlling for degree of breathlessness with activity, dyspnea, activity levels, and quality-of-life measures were significantly different, suggesting that as dyspnea worsens, training PLB may be more effective. Given the challenges with health care access, using communication software for the education and management of patients with chronic diseases and their caregivers may be both effective and efficient and especially useful for those who are geographically dispersed or homebound.