Shortness of breath in palliative care

Shortness of breath can be caused by many factors, such as obstruction of the airways, heart failure, fluid around the lungs (pleural effusion), and mucus in the airways. Mental distress often makes shortness of breath worse.

Shortness of breath is treated by treating the cause, while also providing symptom relief for the feeling of breathlessness.

Shortness of breath: Treating the cause

Treatment for shortness of breath is determined by the cause, if possible. Both the physical symptoms and the feeling can be relieved both with medication and by other means.

Shortness of breath caused by heart failure can be relieved with diuretics or other medications affecting the heart or circulation. Some patients with pulmonary diseases find bronchodilators helpful – these are inhaled medications that widen the airways. Medication can be used to decrease mucus secretion, and thick mucus can be made thinner either with medication or by inhaling steam. Infections affecting the lungs can sometimes be treated with antibiotics. If the airways are obstructed because of cancer, radiation therapy may be helpful. Sometimes shortness of breath is caused or made worse by constipation. In that case, treating the constipation and making sure that the patient has regular bowel movements makes diaphragmatic breathing easier.

Fear and anxiety make shortness of breath worse. In such cases, the patient may benefit from being calmed or, if necessary, being given anxiety medication.

Fluid in the lungs or abdomen

If shortness of breath is caused by a build-up of fluid in the pleural space around the lungs or in the abdomen, the fluid can be removed with a small one-time procedure (“pleural tap” or “ascitic tap”) or by inserting a drainage catheter to let the fluid out. However, if the build-up of fluid is caused by metastatic cancer, the fluid usually comes back, meaning that the procedure may need to be repeated several times. In that case, an indwelling catheter can be inserted, which allows the patient to drain the fluid independently with the use of a special drainage container, if needed.

Oxygen therapy

If shortness of breath is caused by a lack of oxygen, the symptoms may be relieved with oxygen therapy. However, in many cases, the problem is not a lack of oxygen; if so, a cool stream of air onto the face (for example, by using a fan) is as effective in treating the feeling of breathlessness as oxygen.

Symptom management with medication

Shortness of breath experienced by patients with an incurable illness can also be relieved with morphine or morphine-like drugs. If shortness of breath is accompanied by anxiety or fear, anti-anxiety medication may be prescribed.

At the end of life, if shortness of breath is causing a great deal of suffering and the symptoms can’t be managed either with medication or by other means, it’s possible to induce a state of light sleep (“palliative sedation”).

Breathing techniques

When the patient is still in relatively good shape, the feeling of breathlessness can be relieved with exercise and muscle training. Physical therapists are able to provide good tips for how the patient can maintain their muscle strength in their current situation.

If shortness of breath is caused by a build-up of mucus, bottle PEP therapy (blowing into a water bottle through a plastic tube) may be helpful in removing the excess mucus. Ask any healthcare unit or a physical therapist for instructions. Physical therapists can also provide guidance on useful breathing techniques, such as pursed-lip breathing.

Shortness of breath on exertion

If shortness of breath occurs on exertion, it’s advisable to take small breaks while moving. Using a mobility aid such as a rollator walker equipped with a seat makes it possible to sit down while taking a break.

Assessing the benefits of oxygen therapy

If the level of oxygen in the patient’s blood is normal, giving the patient oxygen artificially doesn’t ease the feeling of breathlessness. On the other hand, some patients don’t experience shortness of breath even if their blood oxygen levels are low.

Position

The best position to take when experiencing shortness of breath is easily found by trying different positions. Many patients choose to sit or stand leaning forward, or lie either on one side or with the upper body propped up. The patient usually prefers to lie on one side or the other. When the patient is in bed, it’s advisable to prop them up on one side so that the lung that works less efficiently is down. This leaves the lung that works better with more space. While standing or sitting up, a forward lean position may be helpful.

Stream of air

A cool stream of air to the face is often effective in relieving shortness of breath. Ways to create a cool stream of air include using a desk fan or a handheld fan, or opening a window.

Emotions

As the illness progresses, experiencing shortness of breath and a feeling of suffocation may be frightening for both the patient and their loved ones. This fear may then make the shortness of breath worse. Calming the mind and having someone close at hand may ease the fear and the feeling of breathlessness.