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Breathing Problems

Shortness of breath, also known as dyspnoea or breathlessness, refers to the feeling of having difficulty in breathing. The severity may vary from person to person, but the feeling of suffocation can cause much anxiety and distress in many people with cancer. Shortness of breath that is untreated can also lead to a poorer quality of life as it may cause limitations in one’s movements and activities.


Causes of Shortness of breath

Shortness of breath in people with cancer can be caused by many reasons, which may be related or unrelated to cancer:

  • Cancer blocking the airways
  • Fluid surrounding the lungs (Pleural effusion)
  • Chest infection (Pneumonia)
  • Excessive coughing
  • Weak breathing muscles
  • Low red blood cell levels (Anaemia)
  • Pressure from a swollen abdomen or liver
  • Blood clot in an artery in the lung
  • Allergic reactions
  • Side effects of anticancer treatment (e.g. scarring for radiation therapy or surgery)
  • Stress, anxiety or other psychological problems
  • Pain
  • Other chronic problems e.g. asthma, chronic airways disease, heart failure

  

How it can be treated

Your doctor will ask you further questions (e.g. when it started, associated symptoms) and conduct a physical examination, to find out the cause of your shortness of breath. It is important to determine whether the shortness of breath is recent or chronic as the causes and treatments can be different. New or sudden onset shortness of breath usually requires urgent attention to investigate and treat the cause, whilst more chronic shortness of breath can be managed with medicines to relieve the symptom. Your doctor may also order further investigations (e.g. x-rays) if needed. Treatment for dyspnoea depends on its cause. For instance, using antibiotics to treat infection will relieve the shortness of breath caused by pneumonia. Your healthcare team will be able to advise you in detail on the management plan that is most suited to your condition.

Other ways to ease your breathing include:

  • Oxygen therapy, if your lungs are not supplying enough oxygen to your blood
  • Medications that can relieve shortness of breath, i.e. low dose opioids, especially if it is caused by cancer
  • Medications that can relieve excessive coughing
  • Lifestyle changes and other non-pharmacological strategies (Refer to the next section on “What you can do”)


What you can do

The following are some of the do’s and don’ts to help manage your shortness of breath, alongside the treatment prescribed by your doctor.

General / Environment

  • Take medications as prescribed by your doctor
  • Maintain a calm atmosphere
  • Stay in areas with cooler temperatures
  • Encourage air flow directed at face (from window, fan, handheld fan)

  • Avoid smoke / smoking
  • Avoid tight fitting clothing, especially around the waist and chest area

Energy conservation

  • Balance activities with rest throughout the day. Having a slow and steady pace saves more energy
  • Break activities or responsibilities into smaller tasks. Delegate responsibilities and accept help from family and friends
  • Try using assistive devices (E.g. wheelchair, walking aids) to decrease effort taken during movement that may worsen shortness of breath
  • Put frequently used objects within reach, and place chairs around the house so that you can sit down between activities or when moving from room to room

  • Avoid bending and lifting heavy objects

Positions to ease breathing

  • When sitting on your chair or sofa, sit upright with your back against the chair with feet apart, and lean forward with your arms on your knees
  • When standing, lean back against the wall with your feet slightly apart. Keep your shoulders relaxed

  • Avoid positions that puts pressure on the chest and abdomen

Breathing & relaxation

  • Techniques such as massage, music, and meditation can help you relax and ease your breathing
  • Pursed lip breathing helps you to inhale more fresh air and calms you down so that you will feel less breathless. Inhale deeply through your nose and exhale through pursed lips for twice as long as it took to inhale


When to call your cancer care team

Please seek medical attention as soon as possible if you experience any of the following that can indicate complications of your condition:

  • New, sudden breathlessness that does not get better
  • Chest pain or discomfort
  • Thick, yellowish, greenish or blood sputum
  • Pale or bluish skin, nail beds or mouth
  • Cold and clammy skin
  • Fever of > 38 degree celcius
  • Confusion or restlessness
  • Trouble speaking
  • Dizziness or weakness
  • Swelling of face, neck or arms
  • Wheezing

If you have any questions regarding the above, please call the Cancer Helpline at +65 6225 5655 or approach your doctor or nurse for further details.

The above contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers.