Dr. Michael Shapiro has developed a program that should make breathing easier for a patient with malignant pleural mesothelioma.
He equates his breathing program to teaching an elite athlete how to better utilize his lung capacity by using similar concepts that assist people struggling with serious respiratory issues in hospice care.
“We’re not reinventing the wheel, by any stretch of the imagination,” Shapiro told Asbestos.com. “But there are ways to teach people, at all levels, to breath more efficiently. Our goal is to help provide a better quality of life for a patient.”
Shapiro is the chief medical officer at Cornerstone Hospice and Palliative Care in Central Florida. His novel Dyspnea Self-Management Program (DSMP) is now in its second year of showing impressive effectiveness.
He presented his DSMP at the National Partnership for Hospice Innovation Medical Affairs Forum in Phoenix last week.
DSMP is a nonpharmacologic management protocol that helps patients avoid the need for additional medication, severe anxiety and rushed trips to the emergency room when simple breathing becomes overly strained.
His program is especially relevant for the treatment of pleural mesothelioma, the rare and aggressive cancer that starts in the thin membrane surrounding the lungs and is marked by tumors and inflammation that restrict the normal breathing process. As the disease progresses, breathing becomes more arduous.
Even mild physical activity that once was taken for granted becomes a major undertaking when the lungs no longer operate properly.
Patients often find themselves gasping for breath.
“The whole concept of the program is to try and train someone to breathe in a much more relaxed and effective pattern,” Shapiro said. “Whether you have pleural mesothelioma, lung cancer or COPD, we can’t change what is making you short of breath, but patients can try and re-learn effective breathing techniques.”
Part of the program involves breaking the cycle where a sudden shortness of breath causes severe anxiety that quickly leads to a worsening of good breathing habits.
Patients typically begin the program with an assessment period, biofeedback analysis, and making sure that patients and caregivers are properly using the equipment they already have.
The correct use of inexpensive devices, such as a nebulizer, an incentive spirometer or a hand-held fan sometimes can make a difference.
“Part of the program is just making sure that patients and families feel confident in what they are doing,” he said. “That can be very important. We are looking for how we can help with these symptoms without utilizing drugs, doing this in an adjuvant setting.”
The program also includes simple techniques that include pursed-lip breathing, which allows the lungs to take in more air with each breath, and diaphragmatic breathing, which slows down the breathing process and helps relax the body.
“This is not rocket science,” he said. “People who have breathlessness often develop poor breathing habits. Poor form. This is about relearning how to breathe sometimes.”
The program includes physical and psychological training. He relates the program to other levels of training.
“Like anyone’s form, whether you are running, lifting weights or breathing, the more tired you get, the worse the form will get,” he said. “The way to keep the form in line is to train, which first, will give you more endurance, and second, will give you the muscle memory to help you do it correctly.”
Shapiro said that the DSMP protocol has been used in all interdisciplinary care units within the Cornerstone Hospice and Palliative Care umbrella that covers seven counties.
It has been used with more than 150 patients, significantly reducing the number of shortness of breath episodes that required a trip to a hospital emergency room.
“A shortness of breath can be distressing for patients and family,’’ he said. “We can’t take away the cause, but we can give them the tools to manage it. We can educate and empower them to have a sense of control. And hopefully, it adds to the quality of life.”