How to manage shortness of breath?
How to manage shortness of breath?
Although pain, cough and sweating can occur with malignant pleural mesothelioma, breathlessness is often the most common symptom experienced.
There are a number of causes for shortness of breath, and a very important cause is due to a build-up of fluid between the lung and its lining (pleural effusion). This fluid can accumulate to several liters which in itself can be quite heavy. As it builds up, the fluid occupies the space where the inflated lung should be and pressure from the fluid squashes the lung making it difficult to breathe. Draining the fluid can relieve the pressure and improve your breathing, and if this is the case then it becomes important to look at ways of preventing the fluid from building up again. If your lung is soft and pliable, putting some powder through a short operation or through a tube into your chest can help “stick” the lung to the chest wall reducing the space for fluid to reaccumulate. If your lung is hardened and cannot expand into the cavity, then inserting a tube (indwelling pleural catheter) that allows you to drain the fluid on a longer term basis can be helpful. Sometimes (particularly in later stages), the fluid can collect in small pockets resulting in only small volumes of fluid. If this is the case, then draining rarely improves shortness of breath.
Breathlessness can also be caused by reasons other than mesothelioma and so it is important to try to identify the underlying cause as managing it successfully may reverse the symptom. Conditions such as infection, low red blood cells (anaemia), poorly controlled pre-existing conditions such as heart failure or chronic obstructive pulmonary disease can all lead to shortness of breath and are managed separately.
When fluid can no longer be drained and there’s no other conditions to address then breathlessness is usually related to the burden of the disease. At this stage, there’s a variety of techniques that can be used to manage and improve symptoms including:
Relaxation and the use of breathing exercises
Positioning such as using a reclining chair or more pillows to promote rest and sleep (being in a more upright position places less restriction on the lungs allowing them to expand and make breathing easier)
Handheld fans to create a breeze
Medication such as low dose morphine to aid breathing
Other drugs delivered using a nebulizer
Oxygen therapy (if oxygen levels in the bloodstream are low)
Gentle exercise is recommended wherever possible. Some will have access to a physiotherapist or fitness coach who can help to plan a program of gentle exercise. Being aware of your restrictions is important but many tasks can still be performed, it may simply take a little longer or require a bit of rest now and then.
The author Mr Simon Bolton has no relevant disclosures to report for this article.