If the patient is having trouble breathing, the body might not get enough oxygen. Either the lungs can’t take in enough air, or the body can’t get enough oxygen through the bloodstream. A number of different problems can cause this, such as lung disorders, blocked airways, pneumonia (a lung infection), weak breathing muscles, or obesity. It can also be caused by pain, immobility, poor nutrition, stress or anxiety, allergic reactions, surgery, anemia, the side effects of chemo or radiation treatment, a tumor, fluid in the lungs, heart failure, and other problems.
What to look for
- Shortness of breath or trouble breathing when resting, eating, or talking, or with exercise
- Chest pain
- Faster breathing
- Faster heartbeat
- Pale or bluish-looking skin, fingernail beds, and mouth
- Cold and clammy feeling skin
- Nostrils flaring when inhaling
- Wheezing
What the patient can do
- Stay calm.
- Sit up or raise the upper body to a 45° angle by raising the bed or using pillows.
- Take medicine or treatments prescribed for breathing (for example, oxygen, medicine for relief of wheezing, inhalers, or nebulizers).
- If you’re not in a lot of distress, check your temperature and pulse.
- Inhale deeply through your nose and exhale through pursed lips for twice as long as it took to inhale. (This is called pursed-lip breathing.)
- If you’re still not breathing easier after 5 minutes, sit up on the side of the bed, with your feet resting on a stool, arms resting on an overbed table or side table with pillows on it, and your head tilted slightly forward.
- If you’re coughing and spitting, note the amount of sputum and what it looks and smells like.
- Tell your cancer team how your breathing problem affects you, especially if you avoid some of your usual activities to keep from getting out of breath.
- Try muscle relaxation to reduce anxiety. Anxiety makes breathing problems worse. If you keep having trouble breathing, ask about medicines that might help.
What caregivers can do
- Using a watch with a second hand to check the patient’s pulse, count the number of beats per minute. (If you also count the number of breaths per minute, do it without telling the patient. If the patient knows you’re counting, they may slow down or speed up breathing without realizing it.)
- Check the patient’s temperature to see if they have a fever.
- When the patient feels short of breath, remove or loosen tight clothing.
- Have the patient sit up in a resting position that feels comfortable to them.
- Remind them to breathe in slowly and deeply, then exhale slowly.
- Remove the patient from extreme temperatures, especially heat, which can make it harder to breathe.
- Note when the patient gets out of breath. (During normal activity, while talking, or when they are at rest?) Also note if it happens when they’re standing, sitting, or lying down.
- Putting the patient in front of an open window or placing a fan that blows gently on the face may help some people.
- Offer medicines or inhalers prescribed for shortness of breath.
- If home oxygen is prescribed, be sure you know how to set it up, use it safely, and what flow rate to use. (Do not change the flow rate without first talking to the cancer team.)
Call the cancer team if the patient:
- Has trouble breathing or chest pain
- Has thick, yellow, green, and/or bloody sputum
- Develops pale or bluish skin, nail beds, or mouth; or if their skin feels cold and clammy
- Has a fever of 100.5° F or higher when taken by mouth
- Has flared nostrils during breathing
- Becomes confused or restless
- Has trouble speaking
- Has dizziness or weakness
- Has swelling of the face, neck, or arms
- Starts wheezing
