Is an antidepressant drug the answer to severe breathlessness?

Have you ever tried breathing through a straw? That is what severe breathlessness feels like. That feeling of being out of breath while your lungs struggle to draw in more oxygen is common in a variety of conditions, such as chronic respiratory diseases, heart diseases, and some cancers and neurological diseases. Currently, about 15 million people in Europe suffer from severe breathlessness, which can be a frightening and distressing experience for both patients and their families.

Launched in 2019, the EU-funded BETTER-B project has set its sights on achieving significant improvements in the treatment of severe breathlessness in patients with advanced disease. The BETTER-B partners are conducting a clinical trial to determine whether an antidepressant called mirtazapine could help reduce severe breathlessness where non-drug treatments cannot be effectively used. To date, 100 patients have been recruited to take part in the trial in centres in Australia, Germany, Ireland, Italy and the United Kingdom.“We are delighted to have 100 patients included in our trial and see the enthusiasm of all teams across Europe to improve the care of these patients whose lives are severely affected by breathlessness. This trial is even more relevant than when it first started due to breathlessness being a key COVID-19 symptom,” states Prof. Irene Higginson of BETTER-B project coordinator King’s College London in a news item posted on the university’s website. “We hope that many more patients will volunteer their time to take part in the trial to help our search for better treatments and new ways of managing breathlessness.”

It is not only the COVID-19 pandemic that makes the trial relevant and well timed, but also the fact that there are currently no licensed drugs for the management of chronic breathlessness. Medical treatments usually address the underlying cause of the disease, but even when the underlying condition has been treated, the symptom of breathlessness can persist and continue to get worse.

New treatments specifically targeting breathlessness are therefore urgently needed. If proven effective, mirtazapine could greatly benefit people living with chronic respiratory diseases such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD).

In an earlier stage of the project, researchers from the BETTER-B consortium conducted a multinational survey to discover how respiratory medicine and palliative care physicians managed chronic breathlessness in advanced COPD, fibrotic ILD and lung cancer. The findings suggested that a wider range of acceptable treatments need to be developed and trialled. Furthermore, there needs to be better dissemination and uptake of jointly developed breathlessness management guidelines to encourage doctors to make appropriate use of existing, evidence-based treatments.

BETTER-B (BETTER TREATMENTS FOR BREATHLESSNESS IN PALLIATIVE AND END OF LIFE CARE) is still actively recruiting patients for the trial. As reported in the news item, the project will result in a new European guideline that provides respiratory and palliative care specialists with advice on how to best manage severe breathlessness.

For more information, please see:

BETTER-B project website