Lung Cancer
Breathlessness and how to manage it
Breathlessness is a common problem for those with lung cancer and may be due to the position of the tumour as well as to physical, psychological, and emotional factors (see 'Lung cancer - signs, symptoms and delay in diagnosis'). It may be caused by fluid round the lung (See 'Pleural effusion and pleurodesis for lung cancer').
Breathlessness can be very tiring and distressing. One man described being extremely breathless while waiting for radiotherapy. Breathlessness may also be due to treatments themselves, such as pneumonectomy, when an entire lung is removed (see 'Side effects of lung cancer surgery').
He becomes very breathless, particularly when walking uphill or climbing stairs.
He becomes very breathless, particularly when walking uphill or climbing stairs.
Have you been given any tips or suggestions from the nurse or the doctors how to manage the breathlessness?
No. My doctor gave me a spray when he thought it was angina, I've never, I've used it once, whether it was right or wrong I don't know. And if this friend who rang up and had breast cancer said she went even more breathless when she was having the radiotherapy. At that stage I shall certainly ask for some help to see whether I can have something to free the airways but I certainly don't want to get dependent on anything, if I can manage I will do.
Treatments, which reduce the size of the tumour may help, and several methods can be used to reopen blocked airways to improve air flow to the lungs (see 'Cryosurgery and other treatments for lung cancer' and 'Diathermy resection for lung cancer').
Apart from treatments to reduce the size of the tumour much can be done to help to alleviate breathlessness. Breathing exercises and relaxation techniques are important. Although some people did not remember being given useful advice about breathing, others remembered that the physiotherapists in hospital taught them how to breathe correctly.
The physiotherapist taught him breathing exercises.
The physiotherapist taught him breathing exercises.
Yes, the physiotherapist would come along and she'd do some movements with my shoulder, try and get my shoulders and my body moving a little bit but mostly it was breathing exercises that she gave me. She reckoned that most people breathe through their mouth when they should breathe their nose which is something I learnt and gave me breathing exercises whereby I breathed in through my nose and then out through my mouth and that then I should do this at regular intervals. I'm supposed to still do them at regular intervals and supposed to just keep my breathing right as that is a problem that I have which it's an ongoing problem. But not, certainly not an insurmountable problem.
After leaving hospital, people said that they worked hard to improve lung capacity, using relaxation techniques, yoga, and exercises. One man, who had had a lobectomy, improved his breathing until he succeeded in climbing mountains. In particular he learnt to use his diaphragm while breathing.
Breathing exercises, relaxation and yoga helped him with breathing difficulties.
Breathing exercises, relaxation and yoga helped him with breathing difficulties.
Have you got any recommendations for people to help with their breathing?
Yeah, again funny when I, as soon as I was, when I was diagnosed, and after I came out of hospital, I'd done everything I could I thought to try and help myself. I did watch me diet somewhat and I joined a yoga club, like two months afterwards. Anyway, I started doing light exercises and plenty of breathing and relaxing, I was trying to get me head together. I also had gone out walking all the time, walked around the park first a little bit and then a bit further like that and then eventually I joined a rambling club which I was able to do, I struggled with that but I kept that up and I've still done that now, and I've climbed mountain after mountain since.
That's good. Are there any particular breathing exercises you do?
I do the alternate nostril breathing, I used to do that all the time and, and then laying in what's called the 'corpse position'.
The what position?
Corpse position, where you lay on the floor and do breathing from the diaphragm. Breathing exercises, you can get them in books from the library, there's even pamphlets out, Roy Castle gave out leaflets on that, on breathing exercises.
A man who had had a lung removed found that physiotherapy, which included swimming, cycling and deep breathing, helped him to double his lung capacity. One man attended an intensive two week course of physiotherapy, arranged by his fire service benevolent fund. Another man explained that he used a music tape to help him to relax and breathe more easily.
Physiotherapy, including cycling, swimming, and deep breathing exercises helped him increase his lung capacity.
Physiotherapy, including cycling, swimming, and deep breathing exercises helped him increase his lung capacity.
What sort of exercises do they suggest?
Some of the exercises were swimming, some of the exercises were in a sauna, like a sauna type pool, which is quite warm water which does help, which did help me with my frozen shoulder. I even did some cycling on static on a static bicycle and I did a lot of exercises using elastic, would you believe? It's a special type of elastic that you do actually moving your arms and your shoulders and also deep breathing exercises which is quite important.
Would you like to show us how you do deep breathing?
Most of my deep breathing I actually, I try and take in a deep breath, as deep as I can and hold it for as long as I can then breathe out very slowly. I try and do this, I still do this to this day, as soon as I get up in the morning before I even do anything I do some deep breathing exercises just on the edge of my bed. Get myself dressed and I come downstairs, I usually make myself a bit of breakfast and then I do some deep breathing exercises then as well. I think it's quite important to try and, you need to use what lung you have got left to its maximum capacity. Most people, even with two lungs you don't use both lungs to their full capacity, you probably only use you know fifty percent of your lung capacity, you know in normal every day living. So when you've had this operation you need to expand your one good lung and try and compensate a little bit.
Describes his relaxation and breathing exercises and suggests some useful tips for breathlessness.
Describes his relaxation and breathing exercises and suggests some useful tips for breathlessness.
Well I can go upstairs and lie on my bed, and play a tape and it's, a woman tells you. You start from your toes, you just lie there and just relax, relax and she starts from your toes and she works up through your feet, through your heels, up your legs, into the body, your arm and then it went up there, but I can never stay awake because it knocks me out. And I can be there for two hours and I wake up and I feel great.
This is relaxation exercises?
Relaxation exercises.
And are there any other breathing exercises you've been doing?
Yeah just normal breathing you know, hold it, and that type of thing. Climbing the stair, it's climb two stairs, stop, let your air out, climb another two stairs, let your air out and then eventually you can say well do three stairs, climb three stairs, let your air out, that type of thing. If you go shopping, balancing your stuff and if you feel a bit breathless, just lean up against the wall if you can, and just lean and just relax you know. People might think you're drunk but you're not, or you can suck a sweet.
Does that help?
Oh yes. Sit on the wall, have an ice cream, sit on the wall and have an ice cream, anything like that. And different types of things you can do to yourself but basically just looking after yourself and watch what you do when you're out.
Health professionals working in the community sometimes run clinics to help people suffering from breathlessness. One man attended a local hospice where a physiotherapist taught him how to control his breathing, which he found hugely beneficial.
He found physiotherapy and breathing exercises provided by a hospice extremely beneficial.
He found physiotherapy and breathing exercises provided by a hospice extremely beneficial.
Oh enormously yes. I can't remember, it's so long ago now I can't remember the things she [the physiotherapist] taught me but most certainly it's become second nature. But the one thing you must never ever do is take a deep breath like that and the secret is control of your exhalation.
Breathing out?
If you breathe out controlled you will breathe in controlled and if you get short of breath don't go (pants) because you're wasting half the breath that you're taking in. You've just got to control it and slow down. It's not easy but nevertheless it works.
What else do they teach you in the breathlessness clinic?
That's it. But it was over a protracted period of, and you have to do the exercises with them and, and you do climb stairs with them and walk around the, the hospice. And I found it extremely beneficial.
Medication may also help to relieve breathlessness. Some people were given inhalers and one man was given a nebulizer to help him to breathe more easily.
After his lobectomy he found that inhalers and a nebulizer helped him to breathe more easily.
After his lobectomy he found that inhalers and a nebulizer helped him to breathe more easily.
Oh only, I started going out after about a week and walking; first twenty yards, then forty and so on until I could, I could walk quite a fair distance. But immediately I felt the chest was tight for lack of breath I would stop and then return.
You said you feel breathless, what sort of advice had you been given in order to help you cope with the breathlessness?
Well I have inhalers and unfortunately of course I, since having had the operation and the radiotherapy I have become very prone to chest infections when I get a cold. So I do, over the last two winters I have had to have a nebulizer for a brief period of a week sometimes when it's got really bad.
Can you explain what that is?
Well that's just a machine that vaporises a drug that you can put a mask on and breathe into the lungs to help the tubes of the lung open up a bit.
Can you remember what the inhalers are called?
The inhalers I have Becotide which is a steroid inhaler that I take twice in a morning and twice at night and I have salbutamol which is for an immediate pick up if you find you're breathless when you're doing something and that can be used up to four times a day.
And were you told to do any particular breathing exercises?
Only deep breathing, deep breathing exercises. But like everything else as the years go by one does tend to become a bit lazy and forget these sort of things.
Many people suggested useful tips to prevent breathlessness. For example, one man said that he took care to bend his knees and that he avoided bending over at the waist when picking things up from the ground. He also avoided house dust and smoky atmospheres, and recommended walking slowly.
Gives useful tips to help with breathing and demonstrates breathing exercises.
Gives useful tips to help with breathing and demonstrates breathing exercises.
Now breathing exercises I do it mainly in the morning and before going to bed but even in between during the day time if I am sitting I do breathing exercises, breathe very heavily, hold it, then out again, hold it, then in again, like that. I used to do it many times a day and that helps me in my breathing.
Would you like to show us how you do one? [He demonstrates]. Thank you, so you breathe in very deeply and then breathe out?
Yes.
That's very helpful.
And especially when I have a little problem of dizziness or something like that, I simply sit down and start the same thing and within two minutes I'm quite alright again.
And to help with your breathing?
Yes, I've got to be a bit careful to keep this little place very clean, not to have the dust because I am allergic to certain things, mainly the house dust, the smoke etc. So I do take full care of these things and that helps me.
And do you have to bend in a particular way or do anything else different?
Yes, bending is a big problem for me. I have to be very careful. If I have to pick up something from the ground I must bend my knees like I am sitting and then pick it up. If by mistake I start picking up straight away then I'll have a breathing problem and I have to sit down and take care of myself. So it is a little bit of thing but I think that is because of the age also, it hasn't got much to do with the lung but in general one has to take care of all these things.
That's very helpful so you take care bending carefully?
Yes
Walking slowly?
Walking slowly, and do as much as possible and even sometimes to speak in a long way, let me say how. Mmmmmmmmmmmmmm, Ooooooooooooooooo, things like this help to maintain and have good breathing most of the time.
Other strategies mentioned for managing breathlessness included climbing stairs slowly, having a chair at the top of the stairs, installing a hand rail, walking with a stick and learning to pace oneself.
Most smokers were advised to give up. One man described how he found it impossible to give up completely but limited his smoking to two miniature cigars per day.
He has been advised to give up smoking to help improve his breathing.
He has been advised to give up smoking to help improve his breathing.
Yes after the operation I had, although I felt a bit breathless I did not think much of it but my doctor decided that I should have some help because of the slight heart murmur. And she advised me to have Combivent which I use three times a day, two puffs each time. That opens the lungs and allows me to breathe easier, and I use the Beclazone [beclometasone] to stop any inflammation of the lungs or other side effects and that's all I take.
Did you get any other advice about how to help feelings of breathlessness?
No apart from (laughs) I've been told not to smoke (laughs) which I must admit I'm very, I'm guilty of to the extent of having two miniature cigars per day. And that, I smoke those two puffs at a time throughout the day and I say I have no more than two and a half miniature cigars a day. I like it, I have to make decisions and I need something to make me feel quiet and able to make those decisions so I'll compromise and say that I smoke no more than that.
Last reviewed May 2016.
Last updated May 2016.
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