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Difficulty breathing

Difficulty breathing is a feeling of discomfort and being short of breath. People who have difficulty breathing often say it feels like they can’t get enough air. Difficulty breathing may also be called shortness of breath, or dyspnea.

Some people with cancer have difficulty breathing. It’s most common in people with lung cancer, mesothelioma and cancer that started in another part of the body and has spread to the lungs (called lung metastases).

Causes

Difficulty breathing can be caused by:

  • a tumour blocking or narrowing an airway
  • a tumour putting pressure on structures around an airway
  • radiation therapy to the lungs
  • some chemotherapy drugs
  • surgery to remove part of a lung
  • a buildup of fluid in the space between the lungs and chest wall (called pleural effusion)
  • a buildup of fluid around the heart (called pericardial effusion)
  • fluid in the abdomen (called ascites)
  • blood clots in the lungs (called pulmonary embolism)
  • superior vena cava syndrome
  • low levels of oxygen in the blood (called hypoxemia)
  • low red blood cell count (called anemia)
  • lung infection and inflammation (called pneumonia)
  • lung diseases such as asthma, emphysema and chronic obstructive pulmonary disease (COPD)
  • heart problems such as congestive heart failure or abnormal heart beats
  • smoking
  • anxiety and stress

Symptoms

Symptoms of difficulty breathing can vary depending on their cause and other factors. Signs and symptoms of difficulty breathing include:

  • shortness of breath or trouble catching your breath
  • feeling like you have to work hard to breathe
  • pain, discomfort or tightness in the chest
  • fast breathing, heartbeat or both
  • wheezing
  • cough
  • feeling panicked or anxious
  • fatigue
  • fever and chills
  • trouble sleeping

If symptoms get worse or don’t go away, report them to your doctor or healthcare team without waiting for your next scheduled appointment.

Diagnosis

Your healthcare team will try to find the cause of difficulty breathing so they know how to manage it. A health history is usually done, and members of the healthcare team often ask questions about your symptoms, past medical problems, if you smoke, and the medicines and treatments you are taking. They will also ask about your difficulty breathing, including when you have it and what makes it worse. A physical exam will be done, including listening to your lungs and checking your temperature, blood pressure, pulse and oxygen levels.

You may need to have the following tests.

Complete blood count (CBC) is used to check for anemia and infection.

X-ray of the chest is done to check for pneumonia or pleural effusion.

CT scan of the chest is done to check for tumours and blood clots.

Pulmonary function tests are done to measure how the well the lungs are working, to check for a blocked airway and to check for low levels of oxygen in the blood.

Bronchoscopy is done to diagnose problems in the windpipe and airways.

Electrocardiogram (ECG) is done to check the health of the heart.

Find out more about these tests and procedures.

Managing difficulty breathing

Difficulty breathing is best managed by treating the cause. Once the cause is known, your healthcare team can suggest ways to manage difficulty breathing.

Self-care

Self-care is what you can do to help deal with difficulty breathing.

Try different positions to find which ones help you breathe easier. You can try sitting upright and leaning forward slightly. You can also try using pillows to prop up your head and upper body when you are sleeping.

You can try controlled breathing or pursed-lip breathing. Breathe in slowly through your nose, hold your breath for a few counts and then breathe out through pursed lips like you are whistling. You can also try relaxation exercises or meditation to help ease anxiety when you have trouble breathing. Ask your healthcare team for books or videos that may be helpful.

Plan your daily activities ahead of time to save energy. Take regular rest breaks, especially during activities that tend to cause difficulty breathing.

Try sitting near an open window or in front of a fan to get extra air. Opening a window or lowering the room temperature may also help because cooler air is easier to breathe.

Be a non-smoker and avoid second-hand smoke. If you smoke, get help to quit. Find out more about ways to quit.

Ask your healthcare team for other ways you can cope with difficulty breathing.

Medicines

Medicines are commonly used to manage difficulty breathing. They are usually given orally (as a pill by mouth) or intravenously (through a needle into a vein). Some medicines can be inhaled as a fine mist of liquid through a device called a nebulizer.

Medicines that may be used to manage difficulty breathing include:

  • opioids such as morphine (MS Contin, Statex, MOS)
  • anti-anxiety medicines such as lorazepam (Ativan)
  • corticosteroids such as dexamethasone (Decadron, Dexasone) or prednisone
  • medicines that open your airways (called bronchodilators)
  • antibiotics for pneumonia or other infections
  • anticoagulants for blood clots
  • diuretics or other drugs for heart problems

Oxygen therapy

Oxygen therapy is a treatment that gives you extra oxygen. It makes sure you get enough oxygen if you have difficulty breathing. You breathe the oxygen in through a mask over your mouth or through tubes in your nostrils. Oxygen therapy is usually only helpful if you have low levels of oxygen in your blood (called hypoxemia).

Other treatments

The healthcare team may offer the following treatments to help manage difficulty breathing.

Thoracentesis may be used to drain an abnormal buildup of fluid in the space between the lungs and chest wall (called pleural effusion). The doctor inserts a hollow needle through the skin into the space between the lungs and the chest wall (called pleural cavity). The doctor uses the needle to drain extra fluid from the chest. Find out more about thoracentesis and pleural effusion.

Paracentesis may be used to drain an abnormal buildup of fluid in the abdomen (called ascites). The doctor inserts a hollow needle or plastic tube (called a catheter) through the skin into the abdomen. The doctor uses the needle to drain extra fluid from the abdomen. Find out more about paracentesis and ascites.

Stent placement may be done when an airway is blocked or narrowed. This can happen when a tumour grows inside the airway or puts pressure on structures around the airway. A stent is a small tube that can be placed inside an airway to hold it open. The doctor inserts it into the airway using bronchoscopy. Find out more about bronchoscopy.

Blood transfusion may be done if red blood cell counts are low. Find out more about blood transfusion.

Cancer treatments may be used to help shrink and control the cancer that is growing in the lungs and airways. These treatments include radiation therapy, chemotherapy or laser therapy. Find out more about cancer treatment.

mesothelioma

A tumour that starts in the mesothelial tissue that lines several body cavities, including the chest (pleura), heart (pericardium) and abdominal cavity (peritoneum).

Mesothelioma can be non-cancerous (benign) or cancerous (malignant). Malignant mesothelioma is associated with exposure to asbestos fibres.

superior vena cava syndrome

A group of symptoms that include coughing, difficulty breathing, headache, dizziness, fainting and swelling or flushing of the neck, face and upper arms.

Superior vena cava syndrome occurs when the superior vena cava (the large vein that carries blood from the head, neck, arms and chest to the heart) is compressed by a tumour or blocked by a clot.

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