Care During Chemotherapy and Beyond
Dyspnea (Shortness of Breath)
What is dyspnea?
- Dyspnea is a condition where you are experiencing shortness of breath, or breathlessness.
- Dyspnea is also the uncomfortable sensation of breathing. Normally, our bodies will
regulate the act of breathing without even having to think about it.
- You may experience dyspnea at rest, or on exertion (when you perform any activity
no matter how small), if you have certain conditions. Common causes of dyspnea include:
- Heart problems - including:
- Irregular heart beats
- Fluid accumulation around the heart due to certain forms of cancer (pericardial
- A recent heart attack which may be blocking blood flow
- Heart failure- when your heart is not working as well as it should
- Lung problems - including:
- A blockage by a foreign body in your upper or lower airway passages, by tumor, infection,
or even may be caused by choking on a piece of food
- People with cancer of the lymph nodes in your chest may get a blockage of blood
flow through the blood large vessels. This is called superior vena cava (SVC) syndrome.
People with Hodgkin's disease, lung or breast cancer are most susceptible.
- Constriction of your lung passages caused by secretions are common in acute (happening
suddenly), or chronic (occurs for a long time) bronchitis, asthma, and Chronic Obstructive
Lung Disease (COLD).
- Fluid accumulation in your lungs due to a tumor or infection (pleural effusion)
- Pneumonia - caused by one of many types
- Upper Respiratory Infection (URI) - either caused by a virus or bacteria
- Pulmonary fibrosis - lung damage from radiation, chronic diseases, or chemotherapy
- Pulmonary toxicity - lung damage from chemotherapy, radiation therapy, or chronic
- Pneumothorax - a collapsed lung from tumor or trauma (like a car accident, or a
gun shot wound)
- Blood clots in your lungs (pulmonary emboli)
- Anemia - Low blood hemoglobin (Hgb) counts that may occur with blood loss, if you
are low in iron stores, or after chemotherapy
- If you are hyperventilating, or breathing really fast due to fear, anxiety, or unknown
- Things that may also put you at risk (called risk factors) for developing dyspnea
- Smoking cigarettes
- Environmental irritants, such as pollution, chemicals and hair spray
- If you are elderly, or have an altered immune system from chemotherapy, long-term
steroid use, or chronic diseases
- You may be treated with antibiotics if there are bacteria present in a sputum sample,
or if your healthcare provider is concerned that bacteria caused your infection.
- If your bronchitis, pneumonia or other cause of dyspnea are due to a virus, your
symptoms may take 2 or more weeks to resolve, but antibiotics won't help. Treatment
of a virus includes cough medications, drinking lots of fluids, and avoiding irritants.
- Your dyspnea may be due to a chronic, or a long-term disease, such as pulmonary
fibrosis, or chronic bronchitis. You may go through periods when you feel well,
and then go through periods when you feel ill.
- With some causes of dyspnea, such as chronic bronchitis, and pulmonary fibrosis,
severe outbreaks of cough, shortness of breath and congestion (called exacerbations),
may last for a few months at a time, and occur a few times a year.
What are some symptoms to look for?
- You may notice chest tightness, difficulty getting a good breath, feelings of breathlessness,
or that you is hungry for air.
- You may notice that you are wheezing, when you breathe.
- You may have fever, chills, or a headache.
- You may have pain in your muscles, or pain in your lungs when you take a deep breath,
especially if you are coughing really hard, for long periods of time.
- You may be overly tired, or very weak (fatigued). It may be hard for you to do any
kind of your normal activities.
- You may have sudden onset of coughing spellsor a long-term (chronic) cough.
You may or may not be able to bring up any secretions (sputum), or you may bring
up greenish-yellow, or rusty-colored sputum.
- You may experience shortness of breath, either at rest or while performing any type
of activity. This may include walking to the door, or climbing stairs.
- You may have trouble lying flat in bed, and you may have to sleep on 2 or more pillows.
Your shortness of breath may cause you to wake up in the middle of the night.
- If your heart may not be working as well, your legs may be swollen, especially in
your feet and ankles. You may gain "water" weight easily, or feel bloated.
Things you can do:
- Make sure you tell your doctor, as well as all healthcare providers, about any other
medications you are taking (including over-the-counter, vitamins, or herbal remedies).
- Remind your doctor or healthcare provider if you have a history of diabetes, liver,
kidney, or heart disease. If you have a family history of heart disease, stroke,
high blood cholesterol, or high blood pressure, in a first or second-degree relative,
you may be at risk for certain problems. Notify your healthcare provider if you
have any of these diseases in your family.
- If you are smoking, you should quit. If you do not smoke, avoid smoke-filled rooms.
Smoking first or second-hand can damage lung tissue, and make your dyspnea worse.
Discuss with your healthcare provider techniques that can help you quit.
- Avoid people who are sick. Wash your hands often, with soap and water, for at least
15 seconds at a time. Use tissues when you sneeze or cough.
- Do not share eating or drinking utensils with anyone.
- If you are over the age of 65 years, or have an altered immune system due to chemotherapy,
chronic disease or steroid use, the Centers for Disease Control (CDC) recommends
that you receive a flu vaccine every year, and a pneumonia vaccine every 5 years.
Discuss this with your healthcare provider if this is right for you.
- People with lung problems need to circulate air from the bottom of their lungs and
out of your lungs (oxygenation), to prevent infection and pneumonia. Using an incentive
spirometer for 15 minutes a day, twice a day, can help promote oxygenation.
- Controlling secretions through coughing and deep breathing will help you to breathe
easier. Remember, if you are dehydrated, your secretions will be thicker, and harder
to bring up. Make sure to drink 2 to 3 liters of fluids (non-alcoholic, non-caffeinated)
per day, to remain well hydrated.
- Taking warm showers or baths, and using a vaporizer, may help to thin out your secretions.
- Try to exercise, as tolerated, to promote air exchange (oxygenation), and to maintain
your optimal level of functioning. Walking, swimming, or light aerobic activity
may also help you to lose weight, and feel better. Make sure to exercise, under
the supervision of your healthcare provider, and discuss with your healthcare provider
how you can create a specific exercise program to suit your needs.
- If you are experiencing heart failure, which may have caused your breathing problems,
you may be told to reduce the amount of salt you are eating in a day. Many times,
it may be restricted to about 2 grams of sodium per day. A diet lower in salt may
decrease the amount of work that is placed on your heart. You should discuss this
with your healthcare provider how you can specifically use your diet to control
- Try to avoid "environmental allergens" (such as smoke, pollution, and common causes
of seasonal allergies), as well as things that may cause allergies in your home
(hair sprays, mold, dust mites, and pets). These may trigger an episode of coughing
and dyspnea, and make your symptoms worse.
- Keep a diary of your any abnormal symptoms, such as excessive fatigue, shortness
of breath or chest pain, if these are occurring regularly. Write down the foods
that you have eaten, the exercise or activity you were undergoing when the symptoms
occurred, and how you felt before they occurred. This diary may be valuable in determining
the cause of your symptoms, and help you to identify certain "triggers" of your
- Questions to ask yourself, may include:
- Did my symptoms occur gradually, or did this episode come on all of a sudden? Was
I feeling anxious? Did I perform any kind of activity, or was I resting?
- Did I eat any different kinds of foods? Was I around any pets? Did I travel recently?
What did I do differently?
- With severe breathing problems, sleeping at night with your head of the bed elevated
may make it easier to breathe. You may do this by sleeping on 2 or 3 extra pillows.
This will help lung expansion (spreading out), as well as promote the drainage of
- Use relaxation techniques to decrease the amount of anxiety you have. If you feel
anxious, place yourself in a quiet environment, and close your eyes. Take slow,
steady, deep breaths, and try to concentrate on things that have relaxed you in
- You should restrict the amount of alcohol you take in, or avoid it all together.
Alcohol may adversely interact with many medications.
- Participating in support groups may be helpful to discuss with others what you are
going through. Ask your healthcare provider if he or she is aware of any support
groups that would benefit you.
- If you are ordered a medication to treat this disorder, do not stop taking any medication
unless your healthcare provider tells you to. Take the medication exactly as directed.
Do not share your pills with anyone.
- If you miss a dose of your medication, discuss with your healthcare provider what
you should do.
- If you experience symptoms or side effects, especially if severe, be sure to discuss
them with your health care team. They can prescribe medications and/or offer
other suggestions that are effective in managing such problems.
- Keep all your appointments for your treatments.
Drugs that may be prescribed by your doctor:
- Depending on your lung function, and your overall health status, your doctor may
recommend that certain drugs be used to help your lungs function more effectively,
and decrease symptoms. Some of the common drugs that are used to treat lung
problems may include:
- Antianxiety medications: If you are experiencing anxiety with your
dyspnea, depending on the cause, your healthcare provider may prescribe an anti-anxiety
medication, called an anxiolytic. These medications will help you to relax.
These may include lorazepam (Ativan®), or alprazolam
(Xanax®). It is important to take these medications
only when you are feeling anxious. Do not operate heavy machinery, or drive an automobile
while taking these. These medications must be used very cautiously if you have severe
dyspnea. Discuss the risks and benefits of taking this medication with your doctor
or healthcare provider.
- Antibiotics - If your doctor or healthcare provider suspects that
you have a lung infection, he or she may order antibiotic pills or intravenous (IV),
depending on how severe your illness is, and your overall health status. Commonly
prescribed antibiotics for bronchitis, pneumonia and respiratory (breathing) problems
include azithromycin (Zithromax®), and levofloxacin
(Levaquin®). If you are prescribed antibiotic pills,
take the full prescription. Do not stop taking pills once you feel better.
- Anticoagulants - These medications prevent your blood from clotting,
or may be ordered by your healthcare provider if you have a blood clot. Each of
them works in a variety of ways. Depending on your overall health status, the kind
of chemotherapy you are receiving, and the location of the blood clot, your healthcare
provider may suggest warfarin sodium (Coumadin®),
or enaxoparin (Lovenox®).
- Anticholinergic agents - these drugs are given to persons with
chronic bronchitis, emphysema, and chronic obstructive lung disease (COLD). Anticholinergic
agents work in a complex manner by relaxing the lung muscles, which will help you
to breathe easier. A commonly prescribed drug is ipatropium bromide (Atrovent®).
- Bronchodilators - These drugs work by opening (or dilating) the
lung passages, and offering relief of symptoms, including shortness of breath. These
drugs, typically given by inhalation (aerosol), but are also available in pill form.
- Beta-adrenergic receptor agonists (beta-agonists) - Beta-agonists
can be considered bronchodilators, as these drugs relax airway smooth muscle, and
block the release of substances that cause bronchoconstriction, or narrowing of
your lungs, if you are having a lung "spasm." Drugs such as albuterol (Proventil®), or terbutaline (Brethine®),
are commonly used.
- Corticosteroids: Steroids work by decreasing inflammation and swelling,
which may be present with certain lung disorders. People may benefit from steroids,
either inhaled, by pill form, or in the vein (IV).
- Beclomethasone (Beclovent®), an
inhaled steroid, is useful in the treatment of chronic asthma and bronchitis.
Inhaled steroids act directly on the lung tissue, so there are fewer long-term side
effects, compared with a pill or IV form.
- People who have an outbreak of severe shortness of breath and airway inflammation
may be ordered a steroid pill, such as prednisone, for a short period of time. This
is usually given with inhaled steroids.
- Patients with severe asthma may require IV administration of another steroid, methylprednisolone
- Cough medications/Decongestants - may help you to be more comfortable
if you are coughing a lot. Guaifenesin is an active ingredient in many cough medications,
may be given alone, but is often combined with other drugs, such as codeine, to
help your cough. Guaifenesin may also be combined with pseudoephedrine (Sudafed®) as a decongestant, or any one of many medications,
depending on your symptoms. Another common medication you may receive is Hydrocodone
Bitartrate-Homatropine Methylbromide (Hycodan®).
This is a narcotic antitussive (anti-cough medication), which will help relieve
- Diuretics - may be known as "water pills" as they work to prevent
or treat lung congestion by making you urinate out extra fluid. Some examples of
this medication may include furosemide (Lasix®),
and Hydrochlorthiazide. You may receive this medication alone or in combination
with other medications.
- Oxygen therapy - If you are experiencing shortness of breath at
rest, or on exertion, your healthcare provider may see if oxygen therapy is right
for you. You may take oxygen when your symptoms are at their worst. For example,
some people are only on oxygen at nighttime, and not during the day. Some take oxygen
when they are performing activities, but not all the time.
- Your healthcare provider will discuss with you which treatments are helpful to you.
- Do not stop any medications abruptly, as serious side effects may occur.
When to call your doctor or health care provider:
- Fever of 100.5º F (38º C), chills, sore throat (possible signs of infection if you
are receiving chemotherapy).
- If you cough up blood
- Shortness of breath, chest pain or discomfort; swelling of your lips or throat should
be evaluated immediately
- Feeling your heart beat rapidly, or have palpitations
- Any new rashes on your skin
- Any unusual swelling in your feet and legs
- Weight gain of greater than 3 to 5 pounds in 1 week.
- Any symptoms that worsen and do not improve
Note: We strongly encourage you to talk with your health
care professional about your specific medical condition and treatments. The information
contained in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
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