How your doctor can help with breathlessness
Your doctor needs to find the cause of your breathlessness to find the best treatment for you.
They ask lots of questions about your health and your breathing problems. They might give you a questionnaire to help you describe how breathless you feel. This can feel like a lot to deal with if you are very breathless and tired. If you find it hard to answer the questions your family and friends might be able to help.
Your doctor will also examine you. This might include:
- examining your chest and tummy area (abdomen)
- asking you to blow into a tube to measure how much air you can breathe in and blow out (peak flow)
- taking your blood pressure and pulse
- measuring how well oxygen is travelling around the body (oxygen saturation level)
Tests
To get more information about your breathlessness, you might have one or more of the following tests:
- a chest x-ray
- CT scan
- lung function tests
- blood tests
- ultrasound scan of the chest
Finding the right treatment
Your treatment depends on what is causing your breathlessness. There may be several causes. It might be possible to treat some of the causes and still not fully relieve the breathlessness.
Some treatments may have side effects. Ask your doctor about the risks and benefits of different treatments.
Anaemia can make you very tired and you may also become breathless. This is because your blood is carrying less oxygen.
Blood transfusions or iron tablets
If you have mild anaemia, you might just need a course of iron tablets.
With more severe anaemia you may need to have a blood transfusion to bring your red blood cell levels up again. You can have a transfusion as an outpatient or stay overnight in hospital. It usually takes between 4 and 9 hours, depending on how many units of blood you need.
The blood is donated by someone else and is screened for different infections. It is very safe and you should feel much better after the transfusion.
Erythropoietin
Another treatment for anaemia is a drug called erythropoietin (EPO). It encourages your bone marrow to make more red blood cells. Your
levels go up and so does the amount of oxygen your blood can carry.
EPO may help if you have myeloma and your anaemia is due to kidney failure.
Having a chest infection will affect the way you breathe. If you have a serious infection, such as pneumonia, breathing will be even harder.
If you have a chest infection, you will probably need a course of antibiotics. You may have these as tablets or as injections into a vein in your arm.
Once your infection is cleared, your breathing will improve.
Infection during cancer treatment can be very serious (even life threatening). Contact your hospital advice line straight away if you have a temperature or other signs of infection.
Fluid can sometimes collect between the 2 sheets of tissue covering the outside of the lung (pleura). This is called a pleural effusion. The fluid takes up space where your lungs should be. It stops your lungs expanding fully. You have to take shorter breaths and need to make more effort to breathe.
The fluid can usually be drained off, but it can often build up again. A procedure called pleurodesis might stop the fluid building up.
Ascites (a-site-eez) is the medical name for fluid on the abdomen (tummy).
Ascites pushes up onto the which gives it less room to move and causes breathlessness.
If you have ascites, your doctor can put a needle into the abdomen and drain off the fluid. This is called paracentesis (pronounced para-sen-tee-sis) and can help relieve your symptoms and make you feel more comfortable.
If your doctor thinks you will need to have fluid drained regularly, they may suggest a long term tube (catheter).
Laser treatment is a type of surgery. Doctors mostly use laser surgery to treat advanced lung cancer.
They can use it to cut away any tumour that is blocking a main airway and making breathing difficult.
You have this done through a tube that goes into your airways (bronchoscope). To do this you might have a medicine to make you sleepy (sedation) injected through a . Or you might have a general anaesthetic.
Lasers seal off bleeding as they go. So, you don't have to stay in hospital for long after the treatment. You may even be able to go home the same day.
Most hospitals that treat lung cancer carry out laser surgery. The operation usually works very well at relieving breathing difficulties. But it is not a cure. It does not treat cancer that has spread anywhere else in the body. The cancer in the airway may grow back.
If necessary, it may be possible for the laser surgery to be done more than once.
Internal radiotherapy is also known as brachytherapy or endobronchial therapy. Doctors might use it to treat a tumour that is partly or completely blocking your airway.
Your doctor puts a tube (bronchoscope) down the back of your throat into your airway. The radiation is directed to very small areas of the lung. This can help make breathing easier and reduce coughing.
If the tubes that carry air into your lungs have narrowed, making breathing difficult, you can take drugs to open them up again.
These drugs are called bronchodilators. You can have them as inhalers, tablets, or through a mask called a nebuliser.
There are two types of bronchodilator inhalers:
- short-acting bronchodilators
- long-acting bronchodilators
It’s important that use your inhaler correctly. Your specialist nurse will explain how to do this.
Using a nebuliser
A nebuliser is a machine that makes a mist out of a liquid drug, which you then breathe in through a facemask. In hospital, your nebuliser will be attached to the piped air in the ward.
There are home nebuliser kits available to borrow or buy. You may need to have nebulisers as often as every 4 hours, depending on how breathless you are.
Sterile saline (salt water) in a nebuliser may help you if you have a chesty cough. It will loosen phlegm and make it easier for you to bring it up.
Muscle weakness is a cause of breathlessness. Electrical impulses are used to stimulate the nerves in a group of muscles. This can help the muscles to function again.
This treatment is called neuromuscular electrical stimulators (NMES). It might be offered through a breathlessness clinic.
Medicines
Your doctor might suggest medicines to help your breathing.
Your doctor might suggest steroid tablets if side effects from radiotherapy are making you breathless.
Once your breathing improves, your doctor gradually decreases your dose before stopping them altogether.
You should never stop taking steroids without checking with your doctor. Suddenly stopping or lowering your dose can be harmful.
You might find the over the counter cough medicines for chesty coughs helpful, but it really depends on what is causing your cough.
Let your doctor know if you have a new cough or a cough that has got worse. They can check for the cause, such as a chest infection.
Muscle relaxants like diazepam or lorazepam can help you to breathe more fully. They can relax your chest and tummy muscles.
You might have lorazepam as a tablet that dissolves under your tongue or a tablet you swallow.
Breathing problems might make you feel very anxious. These medicines can also help with anxiety.
Opioid painkillers such as morphine can help with breathing problems. They can:
- relieve pain
- slow down your breathing rate (respiration rate)
- improve your sleep
If you are very short of breath, especially when you do any exercise, your doctor might prescribe small morphine doses to help you.
People who are near the end of life may have morphine and other drugs through a syringe driver to help with breathlessness. A syringe driver is a pump that gives drugs at a constant dose. The drugs go through a soft plastic tube to a needle that goes in just under your skin.
You might find it difficult to breathe If your lungs are producing a lot of secretions, Your doctor can give you drugs to help dry up these secretions and may ease your breathing.
Glycopyrrolate or hyoscine hydrobromide
Hyoscine can also make you quite drowsy. You usually have these drugs through a syringe driver. The pump gives the drug from the syringe through a soft plastic tube to a needle that goes in just under your skin. Your nurse will fix the needle in place with a see through plastic dressing stuck over the top.
They might be mixed with painkillers.
Carbocistene
Other drugs such as carbocisteine break down the thickness of your sputum and make it easier to cough up. This can help your breathing. These drugs come in capsules or a syrup.
You may have oxygen therapy if your symptoms don't improve with other treatments. You might get relief from using oxygen if you’re oxygen levels are lower than usual and you are short of breath. But it does not help everyone.
Your nurse will explain more about this if it's suitable for you.
Complementary therapies
Your doctor or nurse might suggest relaxation classes, massage or acupuncture to help your breathlessness.
Many hospitals now run breathlessness clinics and these treatments may be available there.
If you are interested in trying a particular complementary therapy, talk to your nurse. If it is not available at your hospital or clinic, there may be a local cancer support group that offers this type of service. Or they can put you in touch with local practitioners.
Referral to a breathlessness clinic
Some hospitals have set up specialist breathlessness clinics. It won’t just be people with cancer who go to these clinics. There will be people with chronic lung disease there too.
The clinics are usually run by specialist nurses, occupational therapists, and physiotherapists. They can help you learn techniques to manage your breathlessness. The clinics often run over a few weeks, for example, it might be a course that runs between 6 to 8 weeks.
You can learn better breathing techniques, relaxation, and how to pace yourself.
