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Breathlessness

Like pain, breathlessness is a sensation that can be judged only by the person experiencing it.

Breathlessness - Patient Handout

Breathlessness is also called "dyspnea" or "shortness of breath."  All of these terms describe a person's awareness of difficulty in breathing. 

Feeling short of breath does not necessarily mean that you are low in oxygen levels. In fact many people with cancer affecting the chest wall and lungs actually hyperventilate. 

Tell your health care team if breathlessness is a new symptom or if your breathlessness feels more severe.


Experience of breathlessness is commonly described as:

  • "I cannot get enough air"
  • "My breathing is exhausting"
  • "I have difficulty catching my breath"
  • "I feel short of breath"
  • "My breathing makes me feel agitated, irritated, miserable, or depressed . . ."
  • "My breathing requires more work"
  • "My breath does not go in all the way"
  • "I need to take a break or stop what I am doing to catch my breath"

You may experience breathlessness only with physical activity, and be comfortable at rest. Or you may be aware of the effort of breathing even at rest. 


Breathlessness can be caused by many different conditions. It is important that you report any breathlessness to your care team, so that they can determine the cause and treat it as appropriate.


Things that can cause breathlessness or make your breathing worse include:

  • Diseases of the lung, for example cancer, chronic obstructive pulmonary disease
  • Infection
  • Blood clots in the lungs
  • Fluid in the lungs
  • Cough
  • Heart failure
  • General weakness/fatigue/muscle loss
  • Low blood count  ie anemia
  • Pain
  • Eating and digesting food after eating
  • Laughing
  • Anxiety or anticipating a stressful event
  • Constipation
 

Communication is Key. Always tell your health care team (doctor, nurse, pharmacist and other specialists) about any unusual or disturbing symptoms that you experience. Your doctor and health care team can help you with managing your breathlessness.

Sometimes the problem causing the breathlessness can be treated, such as fluid around the base of the lungs ("pleural effusion") or around the heart ("pericardial effusion").


Even when the cause is not able to be removed, for example scarring of the lungs after surgery and/or radiation, there are treatments that can reduce the sensation of breathlessness. These treatments include non-invasive treatments you can do easily yourself as well as some useful drugs.

Your health care team will spend some time trying to find out what causes your breathlessness in order to select the right medication. Since breathlessness may be caused by more than one reason, it is common for more than one medication to be prescribed.


Some medications used to manage breathlessness are:

  • Opioids (while opioids are commonly used to relieve pain, they also have long been used  to reduce the feeling of breathlessness)
  • Corticosteroid medications
  • Anti-anxiety medications (because breathlessness is commonly associated with anxiety)
  • Bronchodilators  ("puffers")
  • Oxygen, if the oxygen level in the blood is below the normal range
 

Breathlessness may start slowly. You may first feel it when climbing stairs or walking up hills. You may think activity is harmful to you and you might stop exercising. But inactivity weakens muscles making them less efficient. 

The weak muscles need to work harder than the toned muscles to bring in the same amount of air and blood circulation. You will breathe faster with smaller breaths to compensate. As a result you feel breathless. Talk with your health care team about exercise.


Try to learn more about your breathlessness:

  • When did the breathlessness begin?
  • What does your breathlessness feel like?
  • What have you tried to relieve the breathlessness?
  • What makes your breathlessness worse?
  • Do you feel exhausted or fatigued most of the time or just sometimes?
  • Are you able to do your daily activities?
  • Can you predict when you will feel short of breath? What seems to be the pattern?
  • Is your shortness of breath associated with certain meals, activities or any of the medications you are taking?

To live with breathlessness you must learn three things:

  1. Learn to control your breathing
  2. Learn to stay calm when you are breathless
  3. Learn how to function and adjust to daily activities while living with breathlessness

Practice these techniques when you are not short of breath. The goal is to help you feel more in control of your breathlessness and give you the skills to better cope with this symptom.


If you experience breathlessness:

  • Stop your activity
  • Get into a resting position with your back straight and head tipped slightly towards your chest
  • Concentrate on your breathing
  • When able, start to breathe out l-o-n-g-e-r. This helps you take a bigger breath in
  • Breathe in through your nose and out slowly through your mouth
  • Relax the tense muscles in the neck, then shoulders and upper chest 
  • Do not talk. Concentrate on your breathing
  • Breathe from the diaphragm, a muscle located just below your ribs
  • Focus on the feeling of air moving in and out of your lungs
  • Reassure yourself that you can gain control over this feeling of breathlessness (the more anxious you are the harder it is to breathe)
  • Rest for a few moments even if you have caught your breath
  •  Used a fan directed at your nose, upper lip and mouth or cheek. Portable battery operated fans may help when you go outside.

Some things to remember are:

  • Take your medications as prescribed ( for example, puffers that will temporarily enlarge the airway or reduce swelling)
  • Catch your breath before starting a new activity. Do not start an activity when you are already short of breath
  • Use walking aides. Consider ones that allow you to sit and rest
  • Allow yourself rest breaks. Slow down and pace yourself
  • Wear slip-on shoes and  bring your foot up to your lap to put on socksIf you smoke, stop

Other helpful tips:

  • Your family and friends will worry about you feeling out of breath. Tell them what helps you feel better. Allow them to help you with activities that you find difficult. They can also learn the breathing techniques so they can coach you when you are short of breath.
  • Rearrange and reorganize your home to save energy and safety, for example, add a chair in the shower/bath tub, sit down to do some chores, move frequently-used items to be stored in lower shelves, cook a larger meal to have enough for a couple of days or have them stored in the freezer.
  • Practice breathing exercises when you are not breathless. The confidence in the ability to cope will make you feel calmer and less anxious.
  • Plan to dress appropriately for the weather and temperature and wear clothes in layers to adjust for comfort.
  • Ensure adequate fluid and nutritional intake
  • Set a goal and a schedule to exercise as part of daily living
  • Include stretching exercises to increase flexibility and light weight training to maintain chest and arm muscle mass including better posture for breathing

While you have breathlessness you should avoid:

  • Holding your breath 
  • Wearing tight fitting clothing
  • Straining when going to the bathroom
  • Bending over, twisting, doing rubbing or scrubbing motions
  • Heavy lifting (anything over 10 pounds)
  • Extreme temperatures such as steam baths and saunas
  • Things that may irritate your lungs such as chlorine from a pool
  • Smoking, fumes and things you are allergic to

Breathlessness can be a lonely, frightening and overwhelming experience. To cope with it you may need to use many of the ideas listed above. If these ideas do not help you feel better, call your health care team for help.


Relaxation Positions:

The following positions promote relaxation and efficient breathing with minimal effort. 

Lean the lower half of your back against a wall with feet placed 12" away from the wall. Your shoulders should be relaxed and  your arms hanging loosely by the sides.
          Stand and lean forward onto something of the required height. With the arms spread wide apart rest your elbows and lower arms. The back should be straight.
          Sit and lean straightforward. Rest your forearms on your thighs with wrists relaxed and feet on the floor.
          Sit leaning forward from the hips with a straight back, resting your head with shoulders and arms on the pillows on a table. Feet should be on the floor. When you are well relaxed your arms should be lying loosely on the table while your shoulders and upper part of the chest rest against the pillows.
          If you are lying down make a slope with three or four pillows with the whole of the side supported. Pillows between the boxspring and mattress help give a gradual slope to your bed.
 
 

‎BCCA library recommended websites: Breathlessness / Dyspnea Websites


BCCA Library pathfinder: Lung Cancer Pathfinder


Symptom management guidelines: Dyspnea

Revised Jul 2014


SOURCE: Breathlessness ( )
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