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Health International

Better Treatments for Refractory Breathlessness

Chronic breathlessness is a distressing and highly prevalent symptom of advanced chronic respiratory diseases. It is associated with social isolation, high healthcare costs and poor prognosis. Currently, there are few effective drug treatments thus, chronic breathlessness represents a huge unmet need.

At the core of the Better Treatments for Refractory Breathlessness project (BETTER-B) is an international, multicentre, randomised controlled trial testing the effectiveness of mirtazapine, an established antidepressant, in patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).

The BETTER-B programme of work also includes an online survey of physicians to understand current clinical management of breathlessness, the production of European wide guidance on the management of breathlessness in palliative and end of life care, and qualitative interviews with trial participants (patients and caregivers) to further understand their experiences.


To deliver a step-change in the evidence-based management of breathlessness in palliative and end of life care.


The interventions we identified have been offered to patients as part of a Breathlessness Support Service. The service provides two outpatient clinic visits to the Cicely Saunders Institute and a home assessment over a six-week period.  Patients are seen by respiratory and palliative care physicians, and their carer has access to a social worker.  Patients are followed up by a home visit with an occupational therapist and a physiotherapist. Patients were provided with a toolkit including the following fact sheets.

Breathlessness Support Service Toolkit


BETTER-B provides a wide-reaching impact by translating the trial and research results to produce recommendations, educational materials and clinical improvements for clinicians and policymakers in palliative, supportive, respiratory, primary and end-of-life care.

Project status: Ongoing

Principal investigators

Irene Higginson

Irene J Higginson

Executive Dean, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care


Sabrina Bajwah

Sabrina Bajwah

Clinical Senior Lecturer and Honorary Consultant in Palliative Care

Nilay Hepgul

Nilay Hepgul

Senior Trial Manager

Adejoke Oluyase

Adejoke Oluyase

Research Associate

Charles Normand csi 200x250

Charles Normand

Professor of Economics of Palliative Care & Rehabilitation


  • Funding body: European Commission
  • Amount: €3.7million
  • Period: January 2019 - June 2023

Project website


  • Palliative
  • Breathlessness
  • Respiratory
  • Mirtazapine
  • Antidepressant
  • International
  • Clinical
  • Trial

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