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.

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The above contents are made available as part of TEMASEK FOUNDATION-ACCESS (Accessible Cancer Care to Enable Support for Survivors) PROGRAMME, a holistic care programme to support cancer patients during their care and recovery journey.

The contents have been approved by the Cancer Education Information Service, National Cancer Centre Singapore (NCCS), for people with cancer and their families and caregivers. However, this information serves only as a guide and should not be used as a substitute for medical diagnosis, treatment or advice. For specific medical conditions, please seek expert medical advice from your healthcare team.

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