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 shortness of breath, or 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 a feeling of “smothering”. Respiration rate, or the rate of breathing, will increase and the chest may retract 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.
If your loved one or patient is experiencing dyspnea, contact their treating physician immediately. The doctor or a 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 your patient is under hospice care, you will want to call the hospice agency. The hospice nurse will give you instructions over the phone and will likely send a nurse out to evaluate the symptoms.
Treating Shortness of Breath
Treatments of dyspnea focus on relieving the feeling of breathlessness. The administration of oxygen is usually the first line of treatment. If the cause of dyspnea is a chronic illness like COPD, medications for that illness may be reevaluated and adjusted if necessary. Morphine is commonly used to relieve breathlessness. Morphine works in several ways to decrease the the sensation of breathlessness; by dilating blood vessels in the lungs, reducing respiration rate, increasing depth of breathing, and reducing levels of anxiety. Anti-anxiety medications such as lorazepam can also reduce anxiety, which can make dyspnea worse, and increase comfort levels.
What You Can Do NOW
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:
- Cool the room and make sure patient has on light weight clothing.
- Use a fan to blow air directly at the patient's face, as long as it is tolerated well.
- Open a window to provide a breeze and fresh air.
- Have the patient sit upright in bed and focus on deep breathing.
- Try 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.
Kinzbrunner, BM; Weinreb, NJ; Policzer, JS; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002.
Ferrell, BR and Coyle, N; Textbook of Palliative Nursing, Oxford University Press, 2006.