Shortness of breath — also known as dyspnea — is a common problem among people with metastatic non–small cell lung cancer (NSCLC).
While it’s hard to know exactly how prevalent it is, a study published in September 2016 in Korea’s Yonsei Medical Journal found that 57 percent of participants with NSCLC experienced this symptom.
A person with dyspnea might be able to breathe normally while sitting or standing, “but [if] they take some steps, go up a flight of stairs, or walk around the mall, [they] feel short of breath,” says Jonathan Riess, MD, an oncologist and a lung cancer specialist at UC Davis Comprehensive Cancer Center in Sacramento, California.
There are a number of causes of shortness of breath in people with NSCLC. “Finding the cause is critical to treating the symptoms,” Dr. Riess notes, adding that potential sources of the problem include the following:
- Growth of the cancer itself
- Blood clots
- Fluid buildup in or outside the lungs
- Exacerbation of chronic obstructive pulmonary disease (COPD)
- Adverse reactions to cancer treatments
If you experience any worsening in your breathing, it’s important to let your doctor know right away so that its cause can be identified and treated. But aside from treatments prescribed by your doctor, there are actions you can take to help improve your breathing.
These tips — which include medical approaches that you should discuss with your doctor and behaviors that you can adopt on your own — may help you manage shortness of breath.
1. If You Smoke, Quit
According to the American Lung Association, smoking tobacco can cause or aggravate shortness of breath in a number of ways — from raising your risk of lung and airway infections to directly limiting the ability of your lungs to take in oxygen.
Talk to your doctor about joining a smoking cessation program if you think you need help kicking the habit.
2. Focus on Movement and Taking Deep Breaths
“Taking deep breaths and walking around as much as possible helps keep the lungs open,” says Riess.
If they don’t regularly and fully fill up with air, Riess says, the aveoli — tiny air sacs in your lungs where carbon dioxide and oxygen are exchanged between the lungs and the bloodstream — can collapse slightly, leading to an increased risk of infection.
Gentle exercise can also help strengthen the muscles you use during respiration. And breathing retraining techniques, like pursed lip breathing, can help you learn to move air in and out of your lungs more effectively. Talk to you doctor about which types of activities or breathing techniques you may benefit from.
3. Optimize Your Cancer Treatment
Depending on the exact location of your cancer, growth of the cancer itself might interfere with your breathing. This is especially likely, Riess notes, if a growth is located in one of the main air channels in your lungs.
Sometimes, Riess says, the growth of your cancer may be an indication that a different or additional treatment approach would be wise. It’s worth raising this question with your oncologist if you find yourself in this situation because of breathing difficulties.
You should also work with your doctor to make sure you know how and when to use — and how to most effectively use — your metered dose inhaler, or any other devices you may use to administer medication.
4. Work to Lower Your Risk of Blood Clots
Cancer can lead to changes in your blood that greatly increase your risk for a clot, Riess says. Blood clots usually begin in your leg, but they can break away and block arteries that provide oxygen to your lungs — causing chest pain and shortness of breath.
While walking and limiting sedentary time can reduce your risk of blood clots, it may also be necessary for you to take a blood thinner if you are diagnosed with a blood clot, according to Riess. Talk to your doctor about whether you need to take a blood thinner.
5. Treat Infections and Try to Prevent Them
A lung infection — known as pneumonia — is a common reason for breathing problems among people with NSCLC, says Riess, because chemotherapy and certain other cancer treatments can weaken the body’simmune defenses.
Bacterial forms of pneumonia usually require prompt treatment with antibiotics — and plenty of rest and fluids are essential for recovery from all types of pneumonia. You can reduce your risk of future infections by getting a seasonal flu shot, making sure you are up to date with your pneumonia shot, and washing your hands frequently.
6. Treat Adverse Reactions to Your Cancer Treatments
Some cancer treatments — especially immunotherapy and targeted therapies, but also chemotherapy and radiation — can lead to inflammation of the lungs, known as pneumonitis. “It’s kind of an allergic reaction to the drug,” Riess explains, adding that this side effect is becoming more common as cancer treatment approaches evolve to include treatments like immunotherapy.
Talk to your doctor about taking steroids or immunosuppressant drugs to help address pneumonitis, Riess says.
7. Check for Fluid Buildup in and Around Your Lungs
When fluid accumulates in your lungs due to infection, cancer, or cancer treatments, a diuretic like furosemide or having the fluid drained by a doctor may help, according to Riess. "Finding out what is causing the fluid buildup is essential to properly treating it," he notes.
Fluid can also build up between your chest wall and lung, a condition known as a pleural effusion. Draining this fluid, Riess says, can help improve symptoms. Less commonly, he notes, fluid buildup around your heart can lead to breathing difficulties, which can also be improved by draining.
8. Sleep With Your Head Raised
Especially if you have fluid buildup in your lungs, elevating your head may reduce nighttime breathing difficulties, Riess says.
He cautions, though, that some people don't experience much improvement from changing their sleeping posture.
9. Treat COPD Exacerbations
If you have COPD, NSCLC and its treatment, as well as any lung infections, can aggravate your wheezing and other breathing difficulties.
In such cases, Riess says, it’s important that people treat their symptoms with an effective bronchodilator — a medicine (usually inhaled) that opens up the airways. Sometimes, steroids are also needed to reduce inflammation in the airways. Talk to your doctor about treatment options if you have COPD.
10. Manage Any Anxiety You’re Experiencing
Anxiety can play a role in breathing problems, Riess says. “It can be very stressful to be going through cancer treatment and everything associated with it. But I consider anxiety more a diagnosis of exclusion,” he notes, since it’s important to make sure possible other causes are addressed.
Treating anxiety can involve nondrug approaches like relaxation techniques and psychotherapy, as well as medications for both long-term treatment and the management of acute symptoms.
11. Stay Hydrated (Unless You’re Told Otherwise)
The amount of fluid you should consume depends on your exact situation, Riess says. “Too much fluid, sometimes, can cause fluid accumulation in the lungs,” he notes, but he adds that “in the absence of that, keeping well hydrated is generally a good idea."
If the air in your home is dry, another source of moisture to consider is a humidifier. In particular, says Riess, “it can help if you have a dry cough.”
12. Try Using a Fan for Airflow Stimulation
In a small study published in April 2017 in the Asia-Pacific Journal of Oncology Nursing, researchers found that aiming a small, handheld electric fan on the faces of people with lung cancer and dyspnea helped reduce both their perception of breathing difficulties and their actual respiratory rate.
Talk to your doctor about how to try this approach in a safe and effective way.
13. Consider Palliative Care Options
Focusing on treating the symptoms of your cancer can be a worthwhile approach even early in the course of your illness, Riess says. This approach may include opioid drugs like morphine, which can reduce the sensation of not being able to breathe adequately.
In an August 2010 study published in the New England Journal of Medicine, researchers found that patients with metastatic NSCLC who received early palliative care not only had a better quality of life but also tended to live longer — even though they were less likely to receive aggressive end-of-life care.
Riess emphasizes, though, that the best approach will be different for every person. “I think the biggest takeaway,” he says, “is that you need to let your doctor know right away if you’re experiencing shortness of breath so that he or she can try to identify the main cause and treat that.”