Becoming out of breath can be normal. 

It is how the body responds to requiring more oxygen, for example, when people exert themselves physically. 

Getting out of breath in response to exercise is part of keeping fit and strong and is a positive thing. 

However, for many older people, breathlessness is a regular occurrence and can have a negative impact on their abilities, comfort, and quality of life.

Chronic breathlessness happens when people get out of breath every day, even without physical exertion. 

They find it difficult to breathe and often feel like they cannot control it.

Breathlessness is a common symptom in end of life care. 

 

Symptoms 

Breathlessness (Dyspnoea) affects people differently and can affect even the same person differently at different times. 

This is because although being out of breath is a physical symptom, there are other factors that influence a person’s ability to breathe.

People may become panicky or feel overwhelmed and this can make breathlessness feel much worse.

A tight chest is a common feeling when a person experiences breathlessness.

People can also feel exhausted when prolonged breathlessness occurs. 

Regular breathlessness can mean that people are unable to care for themselves effectively; their mobility may also be affected. 

Furthermore, someone who is regularly feeling out of breath may not have much of an appetite or feel able to eat or drink enough.

 

Causes 

Breathlessness is a symptom and there can be many underlying causes.

The four main causes are:

Lung conditions

COPD, Asthma, Pulmonary Fibrosis, Bronchiectasis, Chest Infections including Pneumonia, Pulmonary Embolism, Lung Cancer, Pneumothorax, Fluid in the lungs, Mesothelioma caused by exposure to Asbestos.

Heart conditions

Heart failure, Myocardial Infarction, Coronary heart disease, Atrial Fibrillation. 

Anxiety

Can cause or exacerbate existing breathlessness. Being unable to breathe properly is a frightening experience so the two often go hand in hand.

Poor fitness

The lower someone’s fitness level is the more breathless they will become when they physically exert themselves.

This may be due to old age and frailty, because of disease and ill health. Obesity may also cause someone to have reduced fitness.

Other causes include neurodegenerative conditions such as Motor Neuron Disease, Multiple Sclerosis, Parkinson’s disease, and Huntington’s disease. 

 

Triggers

People are often able to recognise certain triggers that can cause or exacerbate their breathlessness.

Common triggers include:

  • Extremes of heat and cold 
  • Anxiety
  • Depression
  • Physical activity
  • Trying to eat and drink
  • Being in the wrong position, such as lying flat in bed

 

How can breathlessness be managed?

When treating breathlessness, the treatments can be split into pharmacological and nonpharmacological categories.

For clinicians, the most important factor is identifying the cause of the breathlessness and not making assumptions.

Just because a person has a diagnosis of lung cancer does not necessarily mean that this is the cause of their breathlessness.

The person living with lung cancer may have a small tumor in the base of one lung and this may not have ever caused any breathlessness. 

However, they could have some heart failure and a build-up of fluid, and this may be causing the breathlessness at this time.

Older people often have multiple health conditions so it is vital that clinicians ascertain the true cause of the breathlessness. 

Pharmacological measures have a place in treating breathlessness, but nonpharmacological treatment can be equally effective. 

 

Pharmacological treatments

It is common for caregivers to reach for oxygen if a person is struggling with breathlessness; however, it is important to remember that oxygen therapy is a drug and requires a prescription.

Best practice guidelines state that breathlessness in the terminally ill is seldom due to inadequate oxygenation. 

Supplementing oxygen will be of no benefit if saturations are above 92%.

Pharmacological treatments include:

Morphine

Can help someone with breathlessness as the part of the brain that controls breathing is responsive to opioids.

Morphine can relax people and help them with their perception of their dyspnoea.

Corticosteroids

People with advanced cancer often have an elevated inflammatory response. 

Corticosteroids have potent anti-inflammatory properties and this may relieve breathlessness in some patients.

With this type of treatment if no improvement is evident within 5-7 days then it should be discontinued.

Benzodiazepines

These make people feel drowsy and this, in turn, can help people cope with the effects of breathlessness.

Bronchodilators

Bronchodilators work by relaxing the muscles in the lungs, which allows the airways to widen and makes breathing easier. 

Some Bronchodilators help to clear mucus and reduce inflammation in the lungs.

 

Nonpharmacological treatments

One of the most effective ways to help people cope with feelings of breathlessness is to increase the airflow around them.

This is why people often feel that oxygen helps, when in fact it is simply the increased air blowing into their face that is providing relief.

Simply opening a window to increase the breeze in a room can help, ensuring the room does not feel stuffy or hot can benefit people.

Fan Therapy

Fan therapy is often used as an alternative to a natural breeze from an open window.

A tabletop fan or the small handheld fans are reported to be popular amongst people suffering from breathlessness.

Occupational Therapy

Making adaptations to the person’s home or living space can help to make their daily living activities easy to complete, which can lead to a decrease in breathlessness.

Things such as banisters to hold on to when climbing stairs or a seat by the sink in the bathroom.

Breathing Exercises 

Breathing exercises can help people to get their breathing under control and reduce feelings of fear and panic.

One common technique is to imagine a rectangle.

Encourage people to breathe in whilst tracing the small side of the rectangle in their mind.

Use the long side of the rectangle to breathe out.

Many people find that this simple technique can be used anywhere at any time and helps them to stabilise their breathing.

Another technique is to breathe out through pursed lips, as though they are blowing out a candle.

Complimentary Therapies 

When people are deeply relaxed their breathing can become slower and more peaceful, with the effects often continuing after treatment has finished.

Popular treatments include things like Aromatherapy, Reflexology, Massage, and Acupuncture. 

 

The impact of breathlessness

Living with breathlessness can lead people to avoid exerting themselves, which in turn can lead to increased dependence on others.

Being out of breath can be frightening and isolating.

At the end of a person’s life, this can be further exacerbated by feeling out of control, fearful of the future and often generally unwell with advancing disease.

Breathlessness can be a difficult symptom to manage but has a huge impact on a person’s quality of life.

It is vital that healthcare staff continue to try all possible measures until they find adequate relief for people living with breathlessness. 


Breathlessness treatments

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