What Causes Dyspnea?

People with cancer may experience shortness of breath for a variety of reasons. For example, the tumor itself can block airways, press on the lungs, or cause inflammation in the air passageways and cause breathlessness. In addition, cancer treatments like chemotherapy, radiation therapy to the lung, biological therapy, and surgery to remove all or part of a lung, can damage the lungs or cause side effects that lead to shortness of breath.

Some other common causes of dyspnea include the following:

• Anemia (low red blood cell count)
• Airway obstruction
• Pleural effusion (abnormal fluid build-up around the lungs)
• Pulmonary embolism (blood clot in the lungs)
• Ascites (abnormal build-up of fluid in the abdomen)
• Pneumonia
• Emphysema, asthma, bronchitis
• Heart and blood vessel diseases
• Cancer-related fatigue
• Malnutrition
• Lack of exercise, immobility, muscle weakness
• Allergic reactions
• Obesity
• Emotional distress, anxiety

Diagnosing Dyspnea

To diagnose dyspnea, your doctor will review your medical history and perform a physical examination. You may also receive the following diagnostic tests:

• Laboratory testing (e.g., complete blood count)
• Measurement of blood oxygen saturation
• Chest X-ray
• Pulmonary function tests
• Bronchoscopy
• CT scan of the chest
• Echocardiogram (scan of the heart structure)
• ECG (measures electrical activity of the heart)

In addition, your doctor may ask you to describe your breathlessness, including its onset, severity, duration, what makes it better or worse, associated symptoms, and affect on your daily activities. Your doctor will also consider your anxiety level and emotional state.

Treating Dyspnea

Treatment for dyspnea and accompanying symptoms varies greatly, depending on the underlying cause(s). Treatment may involve certain medications, such as anti-inflammatory drugs (e.g., steroids), drugs that promote red blood cell production, or drugs to treat pain or anxiety.

If you have an airway obstruction, your doctor may try to relieve it by shrinking the tumor using chemotherapy or radiation therapy. Your doctor may also use a stent to keep your airway open. To relieve pleural effusion, your doctor may perform a thoracentesis to drain fluid from the lungs. If anemia is causing shortness of breath, you may receive a red blood cell transfusion. If your blood oxygen level is significantly low, you may receive supplemental oxygen.

Treatment for shortness of breath may also involve techniques and lifestyle changes that help to reduce symptoms. For instance, your doctor may recommend physical therapy to strengthen weak muscles, increase lung capacity, and help you perform your daily activities.

Managing Shortness of Breath

Shortness of breath can be very physically and emotionally troubling, particularly when you are battling cancer at the same time. The emotional anxiety that often accompanies a cancer diagnosis can contribute to breathlessness. Feeling short of breath can also make you anxious, which can lead to further breathlessness. Not only can shortness of breath be uncomfortable, it can also interfere with your usual activities, making it difficult to eat, sleep, or socialize with family and friends. It is important to find ways to manage dyspnea to improve your breathing and your quality of life.

When to Call Your Doctor

Breathing difficulties can indicate a highly dangerous condition. Make sure you call your doctor if you:

• Have trouble breathing or chest pain
• Have yellow, green, and/or bloody sputum (mucus)
• Develop pale, bluish, or clammy skin
• Have a fever of 100.5° F or greater
• Become confused or restless
• Have difficulty speaking
• Have swelling of the face, neck, arms, ankles, or calves
• Develop wheezing

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. YOU SHOULD ALWAYS REPORT ANY SHORTNESS OF BREATH TO YOUR PHYSICIAN IMMEDIATELY.

Tips for Relieving Shortness of Breath During Cancer Care

• Use controlled breathing techniques. Focusing on your breathing pattern may help decrease shortness of breath. Take slow, even breaths by inhaling deeply through your nose (for a count of two) and exhaling for twice as long as you inhaled (for a count of four). When you exhale, put your lips together as if you are slowly blowing out a candle. This is called pursed-lip breathing.
• Pace your activities. Plan your day so you use your energy on the activities most important to you first and limit unnecessary activities. If you become short of breath during an activity, stop and rest. Avoid multiple trips up and down stairs and take rest breaks in between and during activities. Also, try to plan activities that involve sitting down, such as listening to music, watching television, reading, or playing board games.
• Try to relax. When you feel short of breath, is important to stay calm since anxiety can make breathing problems worse. Try to focus your thoughts on pleasant things and concentrate on relaxing your hands, arms, and shoulders. A mind-body therapist can recommend strategies, such as relaxation techniques, guided imagery, stress management, meditation, massage, Yoga, and acupuncture. A professional counselor/therapist can also provide emotional support and practical advice.
• Find a comfortable position. Comfortable positioning may help make breathing easier. While in bed, raise your head on pillows so you are close to sitting up. Do not lie flat on your back. Instead, lie with your knees bent, or place a pillow under your knees. When sitting in a chair, sit upright and lean slightly forward with your arms resting on a table.
• Breathe clean, cool air. Good ventilation with low humidity may help alleviate some of the symptoms of shortness of breath. Lower the temperature in the room, open a window, and get rid of smoke and pet dander. It may also help to have a fan blowing cool air across your face. Avoid crowded rooms, warm temperatures, and unpleasant odors.
• Get light exercise. Although you may not want to exercise, it may help to stay physically active (if your doctor permits). Try mild, gentle exercises and light stretching. When climbing stairs, take your time and match your breaths to the steps you take. Loosen your muscles by slowly contracting and relaxing each muscle group one at a time. A physical therapist can help develop a personalized exercise plan for you.
• Maintain proper nutrition. A well-balanced diet provides the energy your body needs to heal and function. Try eating six small meals a day, rather than three large meals. Avoid foods that are difficult to chew. Also, make sure you drink plenty of fluids (e.g., 8-10 glasses of water a day) to prevent dehydration. A dietitian can help you develop a meal plan that is right for you.
• Track your symptoms. For some, shortness of breath has a predictable pattern. For example, you may feel breathless when climbing the stairs or during physical activity. If you notice a pattern, avoid or limit those activities when possible. Ask family and friends for help with cleaning, grocery shopping, and cooking. Try to be aware of situations that make you tense or anxious so you can learn to relax before you become short of breath.
• Follow your doctor's orders. Stay in close communication with your doctor. Let him/her know how your breathing problems are affecting you, including the impact on your daily routine. Your doctor may prescribe certain medications to help decrease shortness of breath. Take your medications/treatments (e.g., oxygen, inhalers, nebulizers) as directed by your doctor.
• Visit a rehabilitation therapist. A rehabilitation program can teach you various techniques and therapies to help decrease shortness of breath. For instance, a rehabilitation therapist can help you learn to retrain your breathing muscles and apply new breathing techniques, such as breathing in slow, rhythmic patterns.

NOTE: THIS INFORMATION IS NOT INTENDED NOR IMPLIED TO BE A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROVIDER REGARDING SHORTNESS OF BREATH.

At Cancer Treatment Centers of America (CTCA), we understand shortness of breath caused by cancer and its treatment can be uncomfortable and upsetting. If you experience shortness of breath, we do everything we can to improve your breathing and your overall quality of life.

At CTCA, you will receive care from a team of cancer experts across multiple disciplines, including an interventional pulmonologist (who specializes in diagnosing and treating diseases of the lungs and respiratory system). Together, you and your care team will develop a comprehensive treatment plan that is tailored to your unique needs.

If you experience shortness of breath at any time during the course of your treatment, your care team will provide different medications and therapies to help you breathe easier. For instance, if pleural effusion is causing shortness of breath, your pulmonologist may perform a procedure called a thoracentesis (to drain fluid surrounding the lungs) or a pleurodesis (to remove fluid from the lungs and prevent further fluid buildup).

You may also receive various rehabilitation therapies to help you breathe easier so you can continue to perform your daily activities. One innovative therapy, auriculotherapy, may help to relieve shortness of breath. Auriculotherapy involves a non-invasive form of electrical stimulation to external ear points that correspond to locations in the body, such as the lungs.

In addition, throughout your treatment, you will receive various other complementary medicine therapies, such as nutrition therapy, naturopathic medicine, pain management, mind-body medicine, and spiritual support. These therapies aim to reduce side effects, such as breathlessness, and promote a sense of well being.

At CTCA, we understand shortness of breath can interfere with your ability to lead a productive, fulfilling life. We are here to support you as a whole person, so you can move beyond cancer and find a new beginning.

I hope this information has helped you in some way. I will check in with you again next month. In the meantime, stay strong and hopeful.