Breathlessness is a common problem with certain types of cancer. This information is about the possible causes of breathlessness and offers advice on ways of reducing and dealing with this symptom.

Breathlessness most commonly occurs when the lungs are affected by cancer. It can also be present as a result of radiotherapy treatment to the lungs or if chemotherapy has caused scarring (fibrosis) in the lung tissue. Breathlessness can also result from other medical conditions, such as anaemia or a chest infection.

It can be a frightening and distressing symptom to live with and can have an effect on all areas of your life. Besides making it difficult to carry out your usual daily physical activities, it can also affect how you feel about yourself and the relationships you have with others. Difficulty in breathing can cause feelings of anxiety and panic that can be difficult to control and, in turn, can actually make your breathing worse.

As there can be many causes of breathlessness, it is important that the cause is identified so that the most helpful treatment can be given. If breathlessness is due to cancer in the lung, treatments such as chemotherapy and radiotherapy can be helpful in reducing the size of the tumour and the symptoms it causes.

Sometimes breathlessness may be due to a pleural effusion. A pleural effusion occurs when cancer cells spread to the membranes around the lungs (the pleura). The cancer cells can cause irritation of the pleura, which causes fluid to build up around the outside of the lungs – between the pleural membranes. The fluid then presses in on the lungs.

Treatment of a pleural effusion usually involves draining the fluid away, through a small tube inserted between the pleural membranes.

If anaemia is the cause of the breathlessness, a blood transfusion may relieve it.

Breathlessness may occur suddenly or may gradually develop over weeks or months. It can often be a very difficult symptom to control. Basic daily activities such as washing and dressing, or types of emotional distress such as anger can trigger breathlessness. There are things that you can do to prevent or reduce breathlessness and these include coping strategies, relaxation and breathing techniques. These can all help to reduce the distress of breathlessness and make your breathing easier.

If your breathlessness is made worse by strong emotions, it may be helpful to see a counsellor or psychologist who can help you to understand and deal with the emotions that cancer can cause.

• Sit down when washing, dressing or preparing food.
• Resist the temptation to hold your breath when dressing and undressing.
• Avoid bending down, and make use of equipment and aids such as grip bars or walking frames. An occupational therapist may be able to come to your home to assess which aids may be helpful for you. Referral to an occupational therapist can be made by your GP or hospital doctor.
• Keep items that you use often within easy reach around your home. To help you to reach items, you can get a pick-up stick from the occupational therapist at the hospital.
• Wear loose clothing around your waist and chest.
• Increase the flow of air around you by opening windows or using a fan.
• Don't have baths that are too hot, and avoid using a shower on your face.
• Pace activities throughout the day to conserve energy. Plan or set goals for activities and balance periods of rest with those of activities.
• When climbing up stairs or a slope breathe in on one step, on the next step breathe out and then wait a moment. Then repeat.
• Have a massage to the head and shoulders, using aromatherapy oils such as lavender for relaxation.
• Pause before speaking and after each sentence.
• If having sex, it can be easier if you are aware of activities or positions that are less likely to make you feel breathless.
• Consider using a wheelchair for long distances. You can get a wheelchair from your occupational therapist at the hospital or from organisations such as the British Red Cross, Dial UK, Assist UK or the Disabled Living Foundation.
• Make relaxation part of your daily routine (see Relaxation techniques).

Often, breathlessness can lead a person to breathe with their upper chest and shoulders in a rapid and shallow manner. This type of breathing uses a lot of energy and causes considerable fatigue.

Breathing control can produce a more relaxed and gentle breathing pattern. It involves relaxing the upper chest and shoulders and breathing at a normal rate, using the lower chest.

It is helpful to sit upright whilst doing these exercises rather than leaning forward.

• Find a quiet place to do the exercises.
• Sit in a comfortable position with your neck, shoulders and back well supported. Relax your shoulders by resting your hands on your thighs and sighing out – this allows your shoulders to fall naturally.
• Place your hand flat on your abdomen (belly) and give a little cough; the muscle you feel under your hand is your diaphragm.
• Breathe in gently and feel your abdomen move out under your hand as the air is drawn into the lower area of your lungs.
• As you do this, try breathing in through your nose and gently out through your mouth. Make your breath out twice as long as the breath in.
• Remember your belly goes out as you breathe in, and in as you breathe out.
• Practise this exercise several times a day (aim to do 5–10 breaths each time you practise).

Physiotherapists can teach you techniques for controlling your breathing. You could ask your hospital doctor to refer you to a physiotherapist.

Simple exercises can help to reduce the anxiety that can make the breathlessness worse. They can give you a sense of control over what can be a difficult and frustrating symptom to live with.

It can be helpful to find a quiet and peaceful environment in which to do these exercises. Make sure that you are in a comfortable position with your shoulders, neck and back well supported, with your arms by your sides or hands cradled on your lap. This technique can take practice. Try it for perhaps 5–10 minutes once a day to start off with.

• Close your eyes gently.
• Begin by breathing out first and then breathe in, just as much as you need. Then breathe out slowly with a slight sigh, like a balloon slowly deflating. Do this once more, as slowly as you can, and as you breathe out feel any tension in your body begin to drain away. Then try to keep your breathing at an even, steady pace.

Once you feel comfortable doing this, you can move on to the next stage:

• Think of different parts of your body in turn.
• Start with your toes and check they are relaxed, comfortable and still.
• Now think about your legs and allow your thighs to relax and roll outwards.
• Next, let your abdominal muscles become soft and relaxed.
• Think about your fingers and let them become limp and still. Allow this feeling of relaxation to spread up your arms to your shoulders.
• Let your shoulders relax and drop easily.
• Your neck muscles will relax if your head is held upright, resting easily balanced on top of your spine, or supported against the back of the chair.
• Allow your face and expression to relax; make sure your teeth are not clenched and let your jaw rest in a relaxed position.
• Now, instead of being aware of parts of your body, become aware of the all-over sensation of letting go, of quiet, calm, restfulness and stillness. Stay like this, listening to your breathing if it helps. If you find your mind becoming busy again, check up where your muscles have tensed and relax them. Get up slowly once you have finished.

Once you feel comfortable doing the above exercises, it can help to imagine pleasant or tranquil surroundings or to listen to some relaxing music. Some organisations such as Penny Brohn Cancer Care supply relaxation tapes.

Painkillers The painkiller morphine can be used to help relieve breathlessness. Morphine is mainly given as tablets, as a drink or by injection. Occasionally it can be breathed in with oxygen through a special mask (nebuliser).

Other types of painkillers can also be helpful in relieving breathlessness and also reducing the distress it can cause.

Steroids and bronchodilators These are types of drugs that are often used to help reduce inflammation and spasm in the airways of the lungs, which in turn helps to reduce breathlessness.

Sedatives These can help to relieve panic and medicines can be given to reduce the anxiety that breathlessness can cause.

Oxygen A cylinder of oxygen with a mask can be helpful to use, particularly after activities needing a lot of exertion. Your GP can organise oxygen for you to use at home.

Antibiotics If breathlessness is being caused by a chest infection, antibiotics can help to relieve this.

Complementary therapies A small research study has shown that acupuncture can be helpful for some people in relieving the experience of breathlessness. Other complementary therapies such as reflexology and homeopathy may also be helpful for some people.

This section is based upon our Breathlessness factsheet which has been compiled using information from a number of reliable sources, including:

• Oxford Textbook of Palliative Medicine (3rd edition). Doyle et al. Oxford University Press, 2004.

For further references, please see the general bibliography.