Chemocare.com
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 effusion)
    • 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 diseases
    • Pneumothorax - a collapsed lung from tumor or trauma (like a car accident, or a gun shot wound)
    • Blood clots in your lungs (pulmonary emboli)

Other causes:

  • 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 causes
  • Things that may also put you at risk (called risk factors) for developing dyspnea may include:
    • 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.

Dyspnea Symptoms:

  • 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 your symptoms.
  • 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 symptoms.
  • 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 secretions.
  • 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 the past.
  • 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 for Dyspnea:

  • 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 (Solumedrol®).
    • 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 your cough.
    • 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 Contact 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.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org