Shortness-of-Breath

Many patients with serious illness experience shortness of breath, a symptom that health care professionals call “dyspnea.” Dyspnea can be very frightening to patients and their families. There are literally hundreds of reasons why someone may feel short-of-breath, some more serious than others. The most common causes are due to a problem in the lungs such as pneumonia, bronchitis or emphysema. But problems in other organs including the heart, kidneys or liver can also lead to the sensation that it is hard to breathe. Examples of other common problems that can lead to shortness of breath include anxiety, panic attacks, anemia and even constipation.

The experience of shortness of breath can range from a general feeling that happens only with physical movement, such as walking up stairs, or it can be so severe that the patient cannot talk, walk or eat. You should tell your doctor about mild shortness of breath as soon as possible. Severe shortness of breath may be a medical emergency. Warning signs that severe shortness of breath needs to be evaluated immediately by a health care professional include:

  • Shortness of breath occurring with chest pain or a change in mental function (change in alertness, memory, language)
  • Shortness of breath so severe that the patient cannot walk, talk or eat, or his/her lips or fingernails have turned blue

Your doctor will figure out the best treatment options for you after looking into the cause of your shortness of breath. The first test your doctor will likely perform will be to place a small device over your finger, a pulse oximeter, to measure the amount of oxygen in your blood. In addition, a chest X-ray and electrocardiogram are usually given to look for common lung and heart problems.

Your doctor may prescribe medications to ease your breathing. For example, antibiotics may be helpful in cases of bacterial pneumonia, while anti-anxiety medications are used to treat patients with anxiety or panic attacks. Other commonly used drugs include bronchodilators to widen the bronchial tubes, diuretics to remove excess fluid from the body and steroids to reduce inflammation.

Oxygen, usually given through a small tube placed in the nose, or through a mask placed over the nose and mouth, is almost always used as a first treatment, but not all patients will feel better with oxygen. Your doctor will ask you whether or not the oxygen is helpful and decide if oxygen therapy should be continued.

Many patients will feel better by changing the position of their bodies. Typically, sitting up, rather than lying down can help. A calm reassuring family member at the bedside can also be very helpful. A bedside fan or open window with a breeze are also simple but very effective treatments to lessen dyspnea.

In severe cases, when there is no simple treatment that can relieve dyspnea, your doctor may prescribe morphine. Morphine is very effective at reducing the feeling of shortness of breath. Your doctor will give you detailed instructions on the best way to use morphine to help you feel better.

Adapted from: Weissman DE. Diagnosis and Management of Terminal Delirium. Fast Fact and Concept 2nd Edition, July 2005. End-of-Life Palliative Education Resource Center, www.eperc.mcw.edu.