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Symptom Management - Shortness of Breath

The following content is from A Caregiver's Guide: A Handbook about End-of-Life Care. It has been reproduced here with permission from The Military and Hospitaller Order of Saint Lazarus of Jerusalem and the Canadian Hospice Palliative Care Association.

Dyspnea

Shortness of breath, also called dyspnea, occurs when the body cannot get enough oxygen. Either the lungs cannot take in enough air, or they cannot deliver enough oxygen to the blood stream. Shortness of breath has many causes, including illness, anxiety or pollution (including tobacco smoke).

What you need to know

Severe shortness of breath can be frightening for both the person experiencing it and anyone watching. Knowing what to expect may make it less disturbing.

The skin around the mouth and nail beds may become blue-tinged.
There may be large amounts of thick mucus that the person can or cannot cough up.
Respirations may sound moist and gurgling.
Breathing may be difficult when moving, talking, or even resting.
Depending on the cause of the shortness of breath and the stage of the progressive illness, some treatment may be considered. Medication and other interventions may also be offered.

How you can offer comfort and care

Your loved one may have less trouble breathing if the surroundings are calm and you follow certain guidelines.
Encourage the quiet presence of a calm supportive family member or friend to help ease the anxiety.
Plan frequent rest periods between activities if the shortness of breath is worse with movement, washing, dressing or talking.
Ask visitors just to sit quietly and calmly so there is no need to talk.
Be sure medication and other interventions prescribed for shortness of breath is taken as directed.
Use a humidifier may help loosen mucus, making it easier for the person coughing.
Avoid standing over or too close to the person. Open a window or use a fan to help give a sense of more surrounding air.
Remove tight or constricted clothing. Use a lightweight blanket as bedding.
Remember to remain calm in the person’s presence. Your distress can make your loved one more anxious, increasing the breathlessness.
Help the person to a position that makes breathing easier. Lying flat often makes shortness of breath worse. Usually a high sitting position is best. Put several pillows or a special seat support pillow at the back. Another helpful position involves leaning on a bed table or high table with the head resting on crossed arms.
Try a recliner chair for sleep as it keeps the body in a semi-upright position.
Do whatever you can to help the person remain relaxed, as tense muscles add to breathlessness.
Medications such as opioids may be prescribed to relieve shortness of breath.

Important Points

Ask for help if:

the person complains of chest pain.
thick, yellow, green or bloody mucus is being produced.
the person cannot get a proper breath for three minutes.
the skin is pale or blue or the person feels cold and clammy.
there is a fever.
the nostrils flare during breathing.

Oxygen Therapy

What you need to know

Sometimes the doctor will recommend oxygen therapy to help ease shortness of breath.

Oxygen can be given in two ways:

through a nose cannula – a short, plastic, disposable tubing that enters the person’s nostrils. (See Figure 27.)
or using a disposable plastic face mask. It fits over the nose and mouth firmly and is attached to the oxygen supply.

How you can offer comfort and care

A mask or cannula needs attention to be as comfortable as possible.

Remove and clean the mask as needed.
Place something soft such as small cotton pads or moleskin between the tubing and the skin to lessen irritation.
Tighten the elastic on a mask so that it fits snugly on the person’s face.
The prongs of the nasal cannula must be in the person’s nose.
Oxygen can dry the inside of the nose. A water-based, non-prescription preparation, such as Secaris^™, can help.

Important Points

Oxygen can fuel a fire.
Do not smoke or light matches in a room where oxygen is in use.
Do not use oxygen around a gas stove.
Do not use oil-based products such as Vaseline^™ or mineral oil close to oxygen.
Use oxygen only as the doctor directs. This may be 24 hours a day or only part of the time.
Oxygen is needed most during activity, such as getting in and out of bed, a chair or the tub, on outings, and when walking.
Make sure a 24 hour supply of oxygen is available, especially on weekends and holidays.
Follow the supplier’s instructions to ensure that the equipment works properly.
Know the number of the supplier to call if you have a problem.
In order to use oxygen at home, you may need a house inspection and approval from your fire department.

Current as of: January 4, 2019

Author: Provincial Palliative and End-of-Life Care, Alberta Health Services

This material is not a substitute for the advice of a qualified health professional. This material is intended for general information only and is provided on an "as is", "where is" basis. Although reasonable efforts were made to confirm the accuracy of the information, Alberta Health Services does not make any representation or warranty, express, implied or statutory, as to the accuracy, reliability, completeness, applicability or fitness for a particular purpose of such information. Alberta Health Services expressly disclaims all liability for the use of these materials, and for any claims, actions, demands or suits arising from such use.