Coping with breathlessness when you have lung cancer

Feeling short of breath can be hard to live with. It can make you feel tired and like everything is a struggle. Some days might seem harder than others. But some things can help you to cope.

What can cause breathlessness?

Chest infections

You might have a chest infection if you are more breathless than usual and are coughing up coloured phlegm or have a temperature. People with lung cancer can be more prone to infections. 

Contact your GP or specialist nurse. You might need a course of antibiotics to clear up the infection. Then your breathing will be easier.

Feeling anxious

If you are very anxious, this can make you feel more breathless. This can be very frightening and make you feel even more anxious.

If you feel panicky, try to slow your breathing down. Concentrate on breathing in and out slowly.

You can practise using breathing exercises so that you are confident about using them when you need to.

You can also learn relaxation techniques. There are online resources or books available. Some support groups can lend you books and other resources. Or you might be able to borrow some from your local library.

A low red cell count (anaemia)

You might be breathless because of a drop in red blood cells. This could be due to a treatment such as chemotherapy or cancer.

Lung surgery

Some breathlessness is normal after lung surgery.  This depends on the type of operation you have had and how fit and well you normally are. If you had breathing problems before the operation, you might still have some problems afterwards.

While some people find that their breathing improves as they recover, others might have long term problems. Talk to your doctor about ways to manage this. You could ask to be referred to a breathlessness clinic.

A build up of fluid between the layers covering the lung (pleura)

Cancer cells can inflame the two layers covering the lung (pleura) and cause fluid. The fluid builds up in the space between the layers (pleural space). This is also called a pleural effusion. The fluid stops your lungs from expanding fully, causing breathlessness.

You can have treatment to stop fluid from building up and help relieve symptoms. This treatment is called pleurodesis.

Muscle weakness 

Muscles that help with breathing can weaken in some people with lung cancer. This is often because of a condition called cachexia. Cachexia is a complex change in the body, causing you to lose muscle and often fat.

A partly blocked airway 

If a lung cancer partly blocks your airway, it can make it hard to breathe.

Your doctor might suggest that you have a tube called a stent put into the airway to keep it open. This can help you to breathe more easily. They might also treat it with heat to destroy the cancer (thermal ablation).

A build up of fluid between the layers covering the heart (pericardial effusion)

Lung cancer that grows into the layers covering the heart can cause fluid to build up. This is also called a pericardial effusion. It affects how well the heart works and cause breathlessness.

Treatment might involve draining the fluid. Your doctor might also suggest other treatments.

Lung tissue changes after radiotherapy (radiation pneumonitis or fibrosis)

Radiotherapy to the chest area might cause some inflammation of your lungs. Soon after the treatment, you might have a dry cough or shortness of breath. This is called acute radiation pneumonitis (pronounced new-mon-eye-tiss).

In a small number of people, a cough and breathlessness can continue. This is because of changes in the lung tissue called chronic radiation pneumonitis. It might start many months or a few years after treatment.

Lung changes caused by chemotherapy, immunotherapy or targeted therapy

Some types of chemotherapy, immunotherapy or targeted drugs used to treat lung cancer can cause changes to the lung tissue. This is rare, but it might cause breathlessness. Your doctor will suggest ways of managing it.

Controlling your breathing

When you are breathless you might find that you breathe faster and your shoulders tense up.

You may feel that this helps you in the short term. But over a long period, it can make it harder and more tiring for you to breathe.

There are several ways of breathing that you can learn to help with breathlessness. They include:

Relaxed tummy breathing

Relaxed tummy breathing is also known as breathing control. It helps you to change your breathing from fast, upper chest breathing to relaxed, slow tummy breathing.

Breathing from the tummy does not come naturally. Practise this method when you are not breathless. Do it for 10 minutes at a time, at least twice a day.

Relaxed tummy breathing can help you to:

• recover quicker if you’re breathless after an activity
• settle your breathing if you feel panicky

How to do it

• Use a handheld fan with this method.
• Make sure you are in a comfortable position. Make sure your head and back are supported. Relax your shoulders and upper chest.
• Place one hand on your tummy. Feel your tummy rise and expand as you breathe in and relax down as you breathe out.
• Breathe gently when practising.

Tips

• ‘Breathe low and slow, relax, let go’. Some people breathe with small, fast breaths from the top of their chest. Take slower, deeper breaths from your tummy. This can help to ease breathlessness.
• Breathe a rectangle. Some people use the image of a rectangle. This can be a book, a TV, a computer screen, a door, a window, a tabletop, or even a picture on the wall. Follow the sides of the rectangle with your eyes while you tummy breathe. Gradually slow the speed at which your eyes move around the edge of the shape to slow your breathing.

Recovery breathing

Recovery breathing can help when you feel very breathless or panicky and you are unable to use relaxed tummy breathing.

This method allows more time for the air to leave your lungs as you breathe out. By doing this, you create more room for the next breath in. Recovery breathing helps to calm your breathing until you can breathe smoothly and quietly from your tummy again.

How to do it

• Use a fan to blow cool air across your face.
• Support yourself in a ‘forward lean position’. For example, stand at a kitchen counter and rest with your arms on the counter while leaning forward.
• Focus on long or relaxed breaths out.

Pursed lips breathing

Some people find breathing in through the nose and out through narrowed lips helps with their breathlessness.

Pursed lips breathing helps to support the airways to open. It helps the air to leave the lungs more easily. This creates more room for the next breath in. You can use pursed lips breathing at the same time as relaxed tummy breathing or recovery breathing.

This 3-minute video shows breathing techniques to help with long term breathlessness.

Moving around

Walking around and going up stairs can be easier if you can control your breathing. Avoid holding your breath when climbing stairs or bending over.

Try to ‘blow as you go’ instead. This means breathing out on effort. For example, blow out when standing up from a chair.

Avoid rushing. Try matching your breathing with the steps you take. For example, take a breath in and out on each step when climbing the stairs.

Planning to make your life easier

You can help yourself by thinking ahead. Make sure the things you need at home during the day are easy to get to. And think about what you are going to do beforehand.

Here are some ideas you can try out:

• Move everything you need downstairs to avoid unnecessary trips up and down.
• Use a cordless phone or a mobile phone.
• Try using a trolley or bag on wheels to carry shopping or washing around.
• For household tasks, plan ahead and get everything you need together before you start.
• Pace yourself and allow rest times – you will get more done if you don't take on too much at once.

Using a fan

Position a fan where it can blow a stream of cool air across your face. This can help to reduce breathlessness. You can also use a handheld portable fan.

Eating and drinking

Chewing and swallowing can be difficult if you are feeling breathless.

Try some of the following tips:

• Have lots of small meals instead of a few large ones.
• Take smaller mouthfuls.
• Avoid foods that are difficult to chew.
• Keep a drink close by to sip through the day.

Remember that you can lose a lot of fluid in your breath, especially if you are breathing through your mouth. Make sure that you drink plenty of fluids. Being dehydrated can make saliva and phlegm stickier. Thick saliva can also make it difficult to chew and swallow.

Asking for help

Many hospitals have specialist clinics for people who have breathing problems. Ask your doctor or nurse to refer you to one in your area.

Staff in the clinic can teach you breathing techniques and much more about coping with breathlessness. If there isn't a special clinic, you could have a chat with a physiotherapist or nurse who specialises in helping people with breathing.

Talking things through may help you to solve a few problems.

If you need oxygen

If you are very breathless you can have oxygen tanks brought to you at home.

You can also get oxygen for when you are away on holiday or travelling.

More information about coping with breathlessness

There are treatments that can help you to breathe more easily and there are things you can do to help yourself.