PrimaryBreathe: co-design of a primary care intervention for chronic breathlessness

<bold>Background</bold> People with chronic lung conditions often experience daily breathlessness despite optimal treatment of the cause. Although specialist breathlessness services are effective, most people cannot access this symptom-focused support. <bold>Aim</bold> PrimaryBreathe aims to develop and test a brief breathlessness intervention delivered by trained primary care healthcare professionals (HCP). Intervention co-design is the first step to optimise acceptability and implementation success in primary care. <bold>Methods</bold> This longitudinal qualitative study involved four iterative phases of information gathering, co-design workshops, prototype intervention delivery and feedback. Participants (n=32) were patients, carers and HCPs from a breathlessness service and primary care, delivering the training and intervention respectively. <bold>Results</bold> People had received little symptom support in primary care and valued the intervention. Although planned as remote, patients wanted at least one of the (median) three 30-min consultations in person. A self-management website was helpful as an adjunct but not standalone. Explaining concepts was key, to give insight into how the symptom can improve when the condition cannot, and how non-drug strategies work by breaking downward spirals of deconditioning, anxiety or inefficient breathing. Strategies were adaptable, reinforced concepts and drove confidence. Primary care HCP training built on existing skills and was short, with a requested ‘top up’ increasing total training time to 2.5 hours. <bold>Conclusion</bold> Delivering a breathlessness intervention in primary care appears achievable and acceptable. The trial-ready intervention is brief and mostly cognitive, limiting impact on primary care resources.