Lung Cancer: Managing Shortness of Breath

Health Writer
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“I can’t breathe!” One of the more prominent symptoms of lung cancer is shortness of breath, formally called dyspnea. It can be uncomfortable, even frightening at times. Any common daily action that requires more breath capacity like climbing stairs, carrying packages, or running for the bus can make you feel like you are gasping for air. Here are some ways to manage that challenge.


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Why am I short of breath?

Depending on how advanced your lung cancer is, or how responsive it’s been to treatment, there are several reasons why you may have dyspnea. You may feel breathless at rest or when physically active, if a tumor is obstructing an airway. Sometimes lung cancer causes fluid buildup in the lungs. Stress and anxiety can make breathing more difficult. Radiation therapy can cause radiation pneumonitis—inflamed, damaged lung tissue.


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How common is shortness of breath?

About 55 to 90 percent of people with lung cancer will have dyspnea. Anything that interferes with breathing can make daily life difficult. As lung cancer progresses, shortness of breath will likely get worse. If you have COPD, congestive heart failure, a pleural effusion, or asthma in addition to lung cancer, the shortness of breath will be worse.


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Breathless, even when you have enough oxygen

The amount of tumor involvement in the lungs and oxygen saturation–the amount of oxygen available in your blood–often do not correlate. So, oxygen saturation is not necessarily the best and only way to measure your feelings of breathlessness. Remember that shortness of breath can be mostly subjective; you can “feel” it despite having adequate oxygen. Dyspnea assessment usually focuses on a variety of scales to gauge how you feel and what measures can help you feel better.


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First treat the underlying cause

If you have a pleural effusion caused by the lung cancer, then draining the fluid (thoracentesis) can improve breathing dramatically. Treating the lung cancer with surgery, chemotherapy, or a combination of approaches can also relieve shortness of breath, although certain treatments like radiation can also worsen it. Palliative care also can ease dyspnea.


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Palliative care for shortness of breath

Early palliative care can reduce shortness of breath, and you can receive this therapy while you are being actively treated for the lung cancer. Palliative care measures can include oxygen therapy, breathing techniques, pain medications—including opioids when appropriate—and anxiety medications to reduce the feelings of stress associated with the perception that you aren’t taking in enough air. There are also a variety of complementary therapies you can try, including acupuncture, acupressure, and mind-body techniques.


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Acupuncture and acupressure

A 2016 pilot study found that ten sessions of acupuncture helped to reduce dyspnea and fatigue in patients with lung cancer. Another study found that ear acupressure helped improve shortness of breath.


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Mind-body and relaxation techniques

Breathing retraining and relaxation techniques that help you focus on your breathing may help you to improve breath depth and quality. In addition, opening windows to bring in fresh air, using a fan or humidifier, and playing soft music can all help you to relax, slow your  breathing, and struggle less for air.


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Are you still smoking?

Some people continue to smoke despite being diagnosed with lung cancer. If you continue to smoke then you will likely make your shortness of breath worse. Smoking will continue to inflame and damage your lungs, which are compromised to some degree. This is a good time to try to stop smoking. Talk to your doctor about the different smoking cessation options that are available. Your body will feel immediate changes.


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Avoid infections and stay hydrated

Make sure to get an annual flu shot and other age-appropriate shots like the pneumococcal vaccine. Wash hands frequently to limit your risk of exposure to infections. Try to avoid getting together with people who are harboring a cold or other infectious disease. These actions will limit some of the causes of dyspnea. Stay hydrated to thin mucus and make coughing easier. An indoor humidifier can also help, but make sure to follow the directions to keep it immaculately clean.


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Exercise, pillow props, and supplemental oxygen

It may seem counterintuitive, but light exercise increases blood flow and delivery of oxygen to your lungs and other organs. Exercise helps to lower the risk of blood clots, a common risk with lung cancer. Sleeping propped up on pillows can mechanically help you to breath more easily. You may also be a candidate for supplemental oxygen; your doctor can order a home setup for you to use just at night or a portable oxygen canister to use during daily activities.


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Incentive spirometer

This device helps you relearn how to take slow, deep breaths. The mouthpiece is connected to the device by a flexible tube. When you inhale, the suction will raise a ball or other marker within a clear cylinder; when you exhale the ball will fall down again. The goal is, with each inhale, to steadily raise and keep the ball hovering until you breathe out. Do this several times, and repeat every hour, or as your doctor recommends.


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Manage anxiety

It’s a vicious cycle. You struggle as you try to inhale, so you become anxious. Then anxiety can make breathing even more difficult since it makes us take faster, more shallow breaths. Try to focus on breathing deeply and slowly. Just being aware and focusing on your breathing can help you feel more in control and less breathless. If necessary, anti-anxiety medications can help.


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Treat the side effects of cancer therapies

Immunotherapy, targeted therapy, and radiation can cause pneumonitis, an inflammation of the lungs. Respiratory medications, steroids, or other immunosuppressive drugs may help to treat the pneumonitis and improve your shortness of breath.


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Take charge of your dyspnea

Don’t let shortness of breath rule your life. Use these recommendations to help you to minimize feelings of breathlessness as much as possible. Remember to try these suggestions with an attitude that if one doesn't work, another may. Also remember that your doctor and health team will likely recognize when shortness of breath is due to treatable issues directly associated with your lung cancer treatments.