21 Jan 2022

Chronic breathlessness has a devastating impact on patients’ lives, severely limiting a patient’s wellbeing and quality of life and that of their family, friends and caregivers. It results in high health, social and informal care costs, and is one of the most frequent causes of emergency hospital admission and attendance.

Palliative and end of life care researchers at the ARC are involved in a major European, multicentre, randomised controlled trial (BETTER-B), which aims to establish whether mirtazapine, currently used as an antidepressant drug, is an effective treatment to reduce severe breathlessness, even when people are not depressed. The aim is to significantly improve the treatment of severe breathlessness in patients with advanced disease.

How will the project be carried out?

The project will test whether mirtazapine is an effective and cost-effective medicine for the relief of patient-reported chronic or refractory breathlessness in patients with chronic obstructive pulmonary disease (COPD) or interstitial lung disease (ILD). This will be achieved through an international, multicentre, randomised, placebo-controlled, double-blind, mixed methods phase III pragmatic trial to test the effectiveness of mirtazapine on patient-reported breathlessness, quality of life, activity levels and other symptoms. 

The project also includes an online survey of physicians to understand current clinical management of breathlessness, and qualitative interviews with trial participants (patients and caregivers) to understand their experiences. The research team will also produce European-wide guidance on the management of breathlessness in palliative and end of life care.

Potential benefits

If mirtazapine is effective, it could benefit patients with many advanced conditions, and their families. This could result in better symptom control and improved quality of life for patients, as well as improved co-ordination of care, more efficient use of services, and a reduction in the number of unnecessary emergency admissions in the last months of life. Equally, if mirtazapine is not effective in patients with breathlessness, the findings will save resources as the results will enable decision makers to recommend that mirtazapine should not be used for this patient group.

The BETTER-B project will translate 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.

Our collaborators

We are collaborating with researchers, statisticians, clinicians, allied health professionals, patients and the public, across 12 international partners. They are: University College Dublin (Ireland), Azienda Unita Sanitaria Locale di Reggio Emilia (Italy), Uniwersytet Mikolaja Kopernika W Toruniu (Poland), Klinikum der Universitaet Zu Koeln (Germany), Gdanski Uniwersytet Medyczny (Poland), Universita Cattolica Del Sacro Cuore (Italy), Ludwig-Maximillians-Universitaet Munich (Germany), University of Nottingham (UK), University of Leeds (UK), University of Technology (Australia), Trinity College Dublin (Ireland), and the European Respiratory Society (Switzerland). 

This project was adopted by the ARC South London and is expected to finish in December 2022.

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