Struggling to Breathe: A Nurse’s Tips for Managing Dyspnea

Dyspnea is the technical word for difficulty breathing. It's a common symptom in people who have lung cancer or have cancer that has spread to the lungs. People who experience dyspnea describe it as difficulty in breathing or shortness of breath. They often compare it to feeling like they are suffocating or being smothered. In many cases, patients may develop anxiety or panic if they feel they cannot breathe. Often their anxiety and fears can make the dyspnea worse. By panicking, patients can become more breathless and begin a cycle that is hard to stop.

Dyspnea occurs when patients have trouble moving air in and out of their lungs. Patients can also experience dyspnea if their lungs are not getting enough oxygen.

Here's some advice from Teresa Knoop, RN, MSN, AOCN, Cancer Information Nurse Specialist, Vanderbilt-Ingram Cancer Center, about how patients can work with their healthcare team to treat their dyspnea and control the anxiety it can cause.

Who Gets Dyspnea?

"Patients with primary lung cancers commonly complain of dyspnea. So do patients who have another type of cancer, such as breast cancer, that has spread to the lungs" says Knoop. But, she explains, people can also have dyspnea if they have any of these health issues.

• A fever, anemia, or infection

• Emphysema

• Heart disease

• Overweight

• Allergies

Some cancer treatments, such as lung surgery, radiation to the lungs, and certain chemotherapy, may damage the lungs and cause dyspnea. Other treatments such as draining the lungs or placing a catheter into the veins of the chest can also cause patients to experience dyspnea.

How Is Dyspnea Evaluated?

Dyspnea is subjective, explains Knoop. "As nurses, we are dependent on the patient to describe and rate the sensation. Generally, we ask patients to explain their breathlessness in terms of ‘mild,' ‘moderate,' or ‘severe.'"

"Dyspnea may prevent people from doing something they normally do with ease," says Knoop, That's why we often ask patients to describe how their dyspnea affects their daily life and their quality of life.

To help you talk with your doctor or nurse about dyspnea, it may help to keep track of how it affects you.   Keep a journal of when you have it, what makes it better, and what makes it worse.

How Can Dyspnea Be Treated?

Treatment of dyspnea is usually directed toward the treatment of the underlying disease. "For example, if fluid is collecting in the lung, the fluid may need to be drained to lessen the dyspnea. Chemotherapy or radiation therapy may shrink a tumor to lessen the dyspnea. If dyspnea is being caused by an infection, antibiotics may be required," says Knoop.

Your doctor may treat dyspnea with medication. Here are some options for that.

• Bronchodilators open a patient's airways and decrease their dyspnea.

• Steroids help reduce any swelling in the lungs that may be causing the shortness of breath.

• Anti-anxiety drugs can help the cycle of panic leading to more breathing difficulties.

• Pain medications can make breathing easier.

Your doctor might also prescribe oxygen. Ask your healthcare team about breathing and relaxation techniques you can try on your own.

What Can a Patient Do to Manage Dyspnea?

"Relaxation exercises, meditation, breathing techniques, conservation of energy, and limitations of activity may be helpful in dealing with dyspnea," says Knoop. These techniques may also control your anxiety level, an important part of treating dyspnea.

It might also be helpful to change the way you sit or sleep. Patients with dyspnea may find it helpful to try sitting upright in a chair, leaning forward slightly, and resting their forearms on the arms of the chair or their knees to help their lungs to expand. Sleeping with several pillows or in a recliner can also help.

Here are two types of breathing exercises to manage dyspnea. Always talk with your doctor or nurse before trying these techniques. It can also be helpful to talk to a respiratory or physical therapist for hints on how to manage dyspnea.

• Diaphragmatic breathing. This is also called abdominal breathing. To do this type of breathing, you must first find your diaphragm.  Here's how: Place your fingers just below your breastbone and breathe in. The muscle that moves is the diaphragm. You may find it useful to lie flat on your back and place a book on your abdomen so you can watch your breathing pattern as the book rises and falls. Your goal is to make the book rise and fall with each breath.

• Pursed-lip breathing. To do this type of breathing, keep the lips pressed together tightly, except for the very center. Take normal breaths. Breathe in through the nose. Then take twice as long to breathe through the center of your mouth.