Shortness of breath, also known as dyspnea, is an uncomfortable awareness of breathing. An estimated 55-70% of patients near the end of life experience this. It can be more distressing than pain to some patients and must be treated promptly.
There are many causes of dyspnea. Some causes are directly related to the underlying disease, especially if the diagnosis is respiratory in nature such as lung cancer and chronic obstructive pulmonary disease (COPD). Other causes can be secondary such as pneumonia or severe weakness. Anxiety is common with dyspnea and can make it worse.
People experiencing dyspnea will often describe it as “shortness of breath”, “tightness in the chest”, “can’t breathe”, or “smothering”. Respirations will increase and the chest may be retracting as the patient uses extra muscles to help them breathe. If oxygen levels are severely compromised, discoloration may occur in the nail beds and lips.
Contact the patient's healthcare provider immediately if any of these symptoms occur. The doctor or nurse can guide you in the best treatment to provide comfort. Because the goal of palliative care and hospice is comfort, you will most likely not want to call 911. If you are under hospice care, you will be calling the hospice company and they will likely send a nurse to the home to evaluate the severity of symptoms.
Medical Treatments
Treatments of dyspnea focus on relieving the feeling of breathlessness. The administration of oxygen is usually the first thing implemented. If the cause of dyspnea is a chronic illness like COPD, medications for that illness may be reevaluated and increased if necessary. Morphine is commonly used to relieve breathlessness. Morphine works in several ways to decrease the the sensation of breathlessness and also reduces anxiety associated with it. Anti-anxiety medications such as lorazepam reduce anxiety, which could be making dyspnea worse, and increase comfort levels.
Non-Medical Treatments
Non-medical interventions are very important in treating dyspnea and can be implemented during medical treatment or while waiting for help to arrive. Some things you can do include:
- Changing the environment – Cool air and low humidity help. Having a fan circulating in an otherwise quiet room and using lightweight clothing and bedding can also provide some relief.
- Physical interventions – Sitting the patient upright and focusing on deep breathing.
- Relaxation techniques – Play relaxing music, use massage or other relaxing touch of the patient's choice. If you are familiar with guided imagery and meditation, both techniques may help.
- Provide emotional support – Listening closely to what the patient has to say and providing reassurance can go a long way.
