Dyspnoea
Cancer and some cancer treatments can cause dyspnoea, also known as breathlessness or shortness of breath. There are several measures that can help relieve this symptom and improve quality of life.
What Is Dyspnoea?
Dyspnoea is the subjective sensation of difficulty breathing. It may present as:
- Shortness of breath.
- A feeling of not being able to take in enough air.
- Rapid or laboured breathing.
- Tightness or heaviness in the chest.
- A sensation of suffocation or air hunger.
The severity of dyspnoea varies from person to person and does not always correlate with blood oxygen levels.
Why Can It Occur?
Dyspnoea can have many causes, and several may occur at the same time:
- Cancer affecting the lungs or airways.
- Pleural effusion (fluid accumulation around the lungs).
- Ascites (fluid accumulation in the abdomen).
- Anaemia (a reduced number of red blood cells).
- Respiratory infections.
- Pre-existing lung disease (COPD, asthma, pulmonary fibrosis, etc.).
- Muscle weakness or loss of physical conditioning.
- Poorly controlled pain.
- Pulmonary embolism (blood clots in the lungs).
- Anxiety or panic.
- Side effects of certain cancer treatments.
It is important to inform your healthcare team about any episode of breathlessness so that potentially treatable causes can be identified.
Assessment of Dyspnoea
Your doctor or nurse may ask you to rate your breathlessness on a scale from 0 to 10, where:
- 0 = no breathlessness.
- 10 = the worst breathlessness imaginable.
Keeping a record of when breathlessness occurs, what activities trigger it and what helps relieve it can assist your healthcare team in tailoring your treatment.
Measures to help you breathe more easily
International guidelines recommend combining treatment of the underlying cause with non-pharmacological approaches.
Breathing Techniques
- Pursed-Lip Breathing
- Breathe in slowly through your nose.
- Purse your lips as if you were about to blow out a candle.
- Breathe out slowly, taking longer to exhale than you did to inhale.
This technique can help reduce the sensation of breathlessness and promote more efficient breathing.
- Diaphragmatic Breathing
- Place one hand on your abdomen.
- Breathe in slowly, allowing your abdomen to rise.
- Breathe out in a relaxed manner.
This technique can help reduce the effort required to breathe.
- Helpful Positions if you become short of breath:
- Sit leaning slightly forwards.
- Rest your arms on a table or on your thighs.
- Keep your shoulders relaxed.
- Avoid lying completely flat if this makes your breathing worse.
- Fresh Air: A handheld fan or a gentle flow of air directed towards the face may help reduce the sensation of breathlessness. This recommendation is supported by international clinical guidelines.
Anxiety Management and Relaxation
Anxiety can increase the sensation of breathlessness and create a vicious cycle:
Breathlessness → Anxiety → Faster breathing → Increased breathlessness
To help break this cycle:
- Try to slow your breathing.
- Practise the breathing techniques described above.
- Use a handheld fan if you find it helpful.
- Listen to relaxing music or practise mindfulness.
- Consider psychological support if anxiety becomes persistent.
Simple Relaxation Exercise
- Sit or lie down in a comfortable position.
- Close your eyes.
- Breathe slowly and deeply for several minutes.
- Gradually relax your feet, legs, abdomen, arms, shoulders, neck and face.
- Focus your attention on your breathing.
- When finished, open your eyes slowly and get up gradually.
Practising regularly can make it easier to use these techniques during episodes of breathlessness.
Activities of Daily Living
Conserving energy is important:
- Prioritise the activities that matter most to you.
- Plan tasks in advance.
- Alternate periods of activity with rest.
- Avoid rushing.
- If possible, perform activities such as washing, dressing and preparing meals while seated.
- Use assistive devices when necessary.
Stay Active
Physical inactivity can lead to loss of strength and may worsen breathlessness. Whenever your clinical condition allows, it is recommended to maintain physical activity adapted to your abilities. Pulmonary rehabilitation and supervised exercise programmes may be beneficial.
Nutrition
Some patients experience increased breathlessness during meals.
The following strategies may help:
- Eat small, frequent meals.
- Choose foods that are easy to chew and swallow.
- Rest before meals.
- Maintain adequate hydration.
If you are experiencing weight loss or difficulty eating, speak with a registered dietitian.
Medical Treatments
Treatment will depend on the underlying cause of the breathlessness and your individual clinical situation.
Treatment options may include:
- Treatment of infections.
- Treatment of anaemia.
- Drainage of pleural or abdominal fluid.
- Bronchodilators where indicated.
- Corticosteroids in selected situations.
- Low-dose opioids for persistent breathlessness that does not respond to other measures.
- Oxygen therapy only when low blood oxygen levels are documented or when specifically recommended by a healthcare professional.
Important Information About Oxygen
Oxygen therapy does not always improve breathlessness. Current guidelines recommend its use mainly for patients with documented low blood oxygen levels and not routinely for all people experiencing shortness of breath.
When Should You Seek Urgent Medical Advice?
Contact your healthcare team immediately or seek emergency medical attention if you experience:
- A sudden worsening of breathlessness.
- Severe chest pain.
- Coughing up blood.
- Fever or chills.
- Bluish lips or fingertips.
- Severe dizziness or loss of consciousness.
- Persistently low oxygen saturation if you use a pulse oximeter.
Healthcare Professionals Who Can Help
Managing breathlessness often requires a multidisciplinary approach involving:
- Medical oncologists.
- Palliative care specialists.
- Specialist nurses.
- Respiratory physiotherapists.
- Registered dietitians.
- Psychologists.
Early involvement of specialist teams can improve symptom control and quality of life.
