How to Manage Your Shortness of Breath

A guide for people with cancer.

This guide is for people who have shortness of breath before, during or after cancer treatment. It can be used by patients, family, friends or caregivers. It does not replace advice from your health-care team.

What is shortness of breath?

Shortness of breath is the feeling that you do not having enough air to breathe. It can also be an uncomfortable feeling while you are breathing. You can have shortness of breath when resting or when you are doing something physical, no matter how small the activity.

Feeling short of breath can be scary and can affect your normal day-to-day activities.

People with shortness of breath often say they feel:

Anxious
Frightened
Nervous
Panicky
Very breathless

What happens during shortness of breath?

Your breathing gets shallower and faster and you may feel like you do not get as much oxygen from your breaths
Your muscles begin to tense and you start to feel nervous to do things
The fear of not being able to breathe makes your shortness of breath worse

What causes shortness of breath?

It is important to find the treatable causes that may be making your shortness of breath worse.The following things can cause shortness of breath:

Muscle weakness
Blood clot
Smoking
Fluid around the lung (pleural effusion)
Lung disease like chronic obstructive pulmonary disease (COPD) or emphysema
Infection, like pneumonia
Low blood count
Side effects from treatment
Anxiety and depression
Low oxygen levels
Blockage in your airway

What can I do to manage my shortness of breath?

Learn breathing exercises and positions

Breathing exercises can be helpful, especially if you have severe shortness of breath. These positions may help you breathe easier and relax:

Standing: Lean against a wall, with your chin slightly dropped towards your chest. Your shoulders should be relaxed and your arms hanging loosely by your sides.

Sitting: Sit and lean forward. Rest your forearms on your thighs with your wrists relaxed and your feet on the floor.

Laying down: Make a slope with a foam wedge in between your box spring and mattress, or with three or four stacked pillows. Lie on your side with pillows supporting you so that your head is higher than your legs.

Abdominal breathing

This type of breathing can help you recover from feeling breathless after an activity. Follow these steps:

Relax your shoulders
Place one hand on your abdomen (belly) just below your chest
Count 1, 2, 3, 4 as you take a breath in and feel your abdomen rise slowly
Breathe out slowly with pursed lips (like you are whistling or blowing out a candle) as you count 5, 6, 7, 8, 9, 10
Repeat this three or four times

Practise this three times a day and before and after an activity.

Recovery breathing

Use this exercise any time you feel very breathless or panicky. Follow these steps:

Use one of the positions listed above
Drop your chin
Breathe in and out while focusing on your breath
Purse your lips
Little by little, blow out for longer periods
Once your breathing slows down, sit up straight and do two or three more abdominal breaths
Rest for a few minutes before starting your activities again

Tip: You can practice recovery breathing while sitting, standing or lying down.

Do relaxation exercises

Relaxing can help you to slow your breathing and make each breath more effective. Follow these steps:

Find a comfortable position
Relax or close your eyes
Now breathe gently
Try to think of something pleasant and create a picture in your mind
You may like to listen to music to help you relax

You can find videos on breathing and relaxation at youtube.com/user/ManagingSOB.

Make lifestyle changes

Take your medications as prescribed. Some medications can help with shortness of breath. You may need oxygen if your oxygen level is low. Your health-care team will test your levels if you are having shortness of breath.

Pace yourself. Break activities down into smaller steps. Plan activities so that you have time to do them slowly and comfortably. Keep things that you use often close by and within easy reach.

Do things in ways that use less energy. Sit down when doing chores and getting dressed. Rest as much as you need to. Avoid heavy lifting. Carry things at your waist or hold them close to your chest. Use a backpack to carry things and fill bags only halfway. Keep your phone close by and stop to catch your breath when you need to during a conversation. A standing or sitting position may be more comfortable during sexual activity with your partner.

Share your feelings. Shortness of breath can make you feel worried and anxious. Share your feelings with family, friends and your health-care team.

Be active. Even if you have severe lung problems, you can still do small amounts of exercise. Take it slowly and use abdominal breathing as much as possible. Increase your exercise slowly over time to improve your breathing and feel better.

Shower or bathe. Keep the bath water shallow and lukewarm. Open a bathroom window to let in fresh air and release steam. Sit in the shower. Position the shower water away from your face. Rest when you need to.

Use abdominal breathing when walking up slopes, climbing stairs or standing up. To climb stairs:

Stand close to the stairs with one hand on the railing beside you
Breathe in as you lift your leg up
Breathe out as you place your leg on the step and raise yourself up

Change the way you eat. Chew your food slowly and take breaks between bites. Try smaller meals more often. If you are having trouble eating, ask your health-care team about trying nutrition drinks.

Use devices to help you save your energy. Some devices can help to cut down on the work your body needs to do in order to breathe. Use pillows to raise your head when lying down. Use a reclining chair with a footrest when sitting. Use a walker or wheelchair if you need one. Ask about using a bedrail, bath board or other safety equipment. Try using a cool fan across your face to help you breathe easier.

Change your environment. Avoid things that can cause shortness of breath, like smoking, perfume, flowers and pets. Open a window or use a fan to get fresh air if the weather is good. Stay inside when the weather is very hot or cold.

Quit smoking. Smoking can make your shortness of breath worse. Your pharmacist or family physician can help you make a plan to quit smoking. They can:

Suggest nicotine replacements (like the patch or gum)
Prescribe medication to help you quit
Help you keep track of your progress

Quitting smoking is the best decision you can make, but quitting is hard. Visit the Canadian Cancer Society’s Smokers Helpline for resources that may help you quit.

When should I talk to my health-care team?

Tell your health-care team right away if you have any of these symptoms:

Breathing that has become harder over a short period of time
You are struggling to breathe and feel very nervous
A sharp pain when you cough or take a deep breath
A fever of 38.3 C (100.9 F) or higher at any time OR 38 C (100.4 F) or higher for at least one hour
A new cough or one that is getting worse
Noisy breathing

Call 911 or go to your nearest emergency department if you ever have:

Breathing problems with dizziness, an increased heart rate or very pale skin
A sudden, new or increasing chest pain
Sudden shortness of breath when you wake up

What is symptom screening?

In Ontario, patients with cancer fill out a symptom screening tool. The screening tells your health-care team about your symptoms and how you are feeling. The tool is called the Edmonton Symptom Assessment System (ESAS). Doing your symptom screening helps you and your health-care team manage your symptoms.

Use the table below to help your health-care team understand your symptoms.

0 to 3	4 to 6	7 to 10
You may have mild shortness of breath if: You can usually sit and lie quietly It comes and goes It gets worse with activity You have no anxiety, or only mild anxiety, while feelings short of breath It is not hard to breathe	You may have moderate shortness of breath if: You feel it almost all the time You have new or worsening shortness of breath Your shortness of breath gets worse with activity and settles only a little with resty It is somewhat hard to breathe	You have have severe shortness of breath if: It comes on quickly or has gotten much worse You almost always feel anxious Breathing is always hard You wake up suddenly feeling short of breath Your shortness of breath makes it hard for you to talk or have a conversation

0 to 3

4 to 6

7 to 10

You may have mild shortness of breath if:

You can usually sit and lie quietly
It comes and goes
It gets worse with activity
You have no anxiety, or only mild anxiety, while feelings short of breath
It is not hard to breathe

You may have moderate shortness of breath if:

You feel it almost all the time
You have new or worsening shortness of breath
Your shortness of breath gets worse with activity and settles only a little with resty
It is somewhat hard to breathe

You have have severe shortness of breath if:

It comes on quickly or has gotten much worse
You almost always feel anxious
Breathing is always hard
You wake up suddenly feeling short of breath
Your shortness of breath makes it hard for you to talk or have a conversation

On this scale, 0 means no shortness of breath and 10 means the worst shortness of breath.

Your health-care team wants to know about your shortness of breath. Your questions and concerns are important. Do not be afraid to share them.

Where to get more information

Visit the websites below for more information and support.

Websites

Support services

Canadian Cancer Society Peer Support Service

For more information on this symptom, or for guides to help manage other symptoms, visit Managing Symptoms, Side Effects & Well-Being.

If you need this information in an accessible format, contact 1-855-460-2647, TTY: 416-217-1815, or [email protected].

The recommendations in this guide are based on published evidence and expert consensus. The information in this guide was adapted from the following patient tools:

Managing Your Breathing (Trillium Health Partners)
Getting the Air You Need (Juravinski Cancer Centre)

This patient guide was created by Ontario Health (Cancer Care Ontario) to provide information about shortness of breath. It should be used for information only and does not replace medical advice. This guide does not include all information available about managing shortness of breath. Always ask your health-care team if you have questions or concerns. The information in this guide does not create a physician-patient relationship between Ontario Health (Cancer Care Ontario) and you.

About this guide

Ontario Health’s patient guides provide Information on managing health-related symptoms (“Information”). The patient guides are for informational purposes only and are not intended to be a substitute for professional medical advice, diagnosis, treatment, or care. The information does not establish a physician-patient relationship between you and Ontario Health. Always seek the advice of a qualified health-care provider.

The patient guides may be amended, reproduced, and distributed without prior permission of Ontario Health for limited use in healthcare settings where patients may benefit from the information. Ontario Health must be cited as the source only when the patient guides are reproduced in their original form. Ontario Health is not responsible for any copyright reproduction of materials.