Shortness of Breath

Many patients with cancer may experience shortness of breath (breathing difficulties) during their illness or treatment.

Shortness of breath can occur as a result of:

• The cancer itself – for example lung cancer pressing on the large airways, or accumulation of fluid around the lungs.
• The treatment – for example chemotherapy causing anaemia (low number of red cells in the blood), or radiotherapy involving part of the lungs.
• Other medical conditions developing during your treatment – such as a chest infection, or blood clots in the lung vessels.
• Existing diseases of the lungs or heart – such as asthma, chronic bronchitis or heart failure.
• Anxiety, leading to feelings of panic which can cause rapid and shallow breathing (over breathing) which can make the problem worse.
• The most common causes of shortness of breath which develop during cancer treatment (other than in the case of lung cancer) are anaemia, chest infections and blood clots in the lungs. Anaemia usually causes mild shortness of breath and tiredness which develops gradually and happens when you make extra physical efforts (for example climbing upstairs or going uphill). This can be unpleasant and distressing but you can learn to manage the symptoms yourself.
• Feeling short of breath, coughing up phlegm and a raised temperature are signs that you may have a chest infection. Please contact your hospital medical team immediately if you are on chemotherapy and have signs of an infection.
• Blood clots in the lungs can also happen which can cause more sudden and sometimes severe shortness of breath. If you have such symptoms you should contact your hospital medical team immediately.

Treatment and Medication

The right treatment for shortness of breath will depend on the cause. The list of available treatments is extremely lengthy, so we cannot go into detail about all the treatments for these conditions on this website. If you would like to know more, please contact your medical team for further advice. They will be able to explain the cause and the thinking behind the treatment chosen for you.

Sometimes, if you have a dry cough leading to breathing difficulties, simple cough linctus may help. However, there are no over-the-counter drugs available that can improve your breathing.

Tips for Coping with Mild Shortness of Breath

Being mildly short of breath is not usually dangerous or harmful but it can make you feel very frightened. If you are breathless, the main thing to do is try and relax and slow your breathing down and take twice as long to breathe out as breathe in. There are lots of things that you can do by yourself or with the help of a friend or relative that may help you to cope with shortness of breath.

Positioning

Getting into a more comfortable position, so that your shoulders and upper chest are relaxed, can help you to breathe more easily. This will allow your tummy and your diaphragm to expand. Many people find the best positions which allow your diaphragm and tummy to expand involve sitting and leaning forward and resting your arms either on your thighs or a secure surface, or standing and leaning forward against a secure surface.

Breathing Control – Abdominal Breathing

• Shortness of breath can be helped using a technique called abdominal breathing.
• Sit comfortably in a chair or upright in bed with your back well supported by pillows. Start breathing gently.
• Place your hand flat on your upper abdomen (just below your rib cage) and then breathe in gently. You should be able to feel your abdomen rise up and out under your hand as air is drawn into the lower chest and then fall down and in as you breathe out.
• Try counting as you breathe – count to two when inhaling through your nose and then exhale through your mouth while counting to four. Your breath out should be longer than your breath in. Some people find it helpful to focus on the rise and fall of their abdomen whilst practising this technique.
• Many people find it helpful to practice this daily, especially when you are not feeling breathless as this exercise can help you regain control when you do experience breathing difficulties. Try to do 10 breaths at a time, and aim to do this at least 3 times a day.

A Fan or Open Window

Many people find it helpful to use a small electric fan, or to sit beside an open window. This can help get the air moving in the room, which can help to relieve your symptoms. Some people also find putting a cool flannel over their face helpful.

Managing Daily Living

Shortness of breath can also make daily living difficult. It is important to stay as active as possible and try to find ways to stop getting so breathless. This may mean changing the way you do things so that you use less energy and need less oxygen. There are some simple things you can do to make life more manageable for yourself.

A traditional approach to saving energy and managing shortness of breath is the 3 ‘P’s’ – Prioritise, Plan and Pace. This involves:

1. Prioritising which activities/tasks are important to do.
Think about your day or week ahead and decide which activities/tasks are most important to you, and which activities/tasks can wait. Sometimes your priorities may be everyday tasks such as shopping or cleaning, and other times they may be social activities such as seeing your friends or family. Everybody has different priorities so your priorities will be entirely individual to you. If there is something you want to do that you know will make you feel tired or short of breath, perhaps make that task your priority for the day and put off other things to conserve your energy. Prioritising activities/tasks will then allow you to plan how to use your energy in the most efficient way.

2. Planning which activities/tasks you need to carry out and how you will do them.
Think about which activities/tasks you made a priority and plan how you will carry them out. Planning ahead can help you to use your energy in the most efficient way. When planning, be realistic about what you are able to accomplish and decide whether you need the help of a friend or relative. Remember to plan frequent periods of rest into your day too.

3. Pacing yourself whilst carrying out your activities/tasks.
Take your time when carrying out activities/tasks. Remember you don’t have to do everything, only the things that are important to you right now. If you are going out or have appointments to make, try not to rush and give yourself plenty of time to get to places. Allow extra time for things that may take you longer than usual, such as climbing stairs or gardening and remember to take plenty of rest breaks.

Physical Activity and Exercise

If you have been told by a doctor that you currently have a blood clot on your lung, a chest infection or anaemia it is not advisable for you to carry out any exercise until these conditions have been treated.

Physical activity may be beneficial for people with shortness of breath. If possible, try to take some gentle regular exercise. Take things at your own pace and use the lower chest breathing technique.

Sleep

Sometimes shortness of breath can affect your ability to sleep well. Here are some additional tips to help prevent shortness of breath affecting your sleep.

Keep your head well supported and raised by propping yourself up with pillows. This will make it easier to breathe.

If you have trouble sleeping or you feel breathless when you wake, try using some relaxation exercises.

Keep a window open or have a small electric fan on overnight to keep the air flowing in the room.

If you have trouble sleeping at night it may help to change a few things about when and where you sleep. It is important to establish a routine in the evenings to help you relax for bedtime. Be patient with any changes you do make as it may take a couple of weeks to get back into a good sleep routine.