Dyspnea (Shortness of Breath) Among Cancer Patients

Defined at its most basic level, dyspnea – also known as air hunger – is difficult or labored breathing, or a feeling of shortness of breath. It occurs when there is an imbalance between the respiratory and the cardiopulmonary systems. An increased heart rate will naturally result in an increased need for oxygen, and in a healthy person the lungs will respond proportionately to this need. However, if this balance is disturbed, it may result in dyspnea or breathing stress. Dyspnea can be one of the most alarming and frightening of cancer symptoms, since it affects the daily functions of those afflicted by it.

The causes of dyspnea are diverse, including, but not limited to: asthma, heart attack, heart failure, pericarditis, chronic obstructive pulmonary disease, bronchitis, cystic fibrosis, obesity and rib traumas. Dyspnea can occur during vigorous exercise (which is normal), but when it occurs at rest, or too quickly after minimal exertion, it could be a sign of serious illness.

Cancer patients experience dyspnea for a variety of reasons. Those who have lung cancer are commonly affected, due to interference with their normal lung function. Patients who suffer from other types of cancer may be affected as well. Any patient who experiences an increased need for energy, whether caused by cancer or the treatment of cancer, is prone to dyspnea.

Dyspnea is in some ways subjective. A patient may tell a doctor that they feel as if they are having difficulty breathing, sometimes describing it as a feeling of pressure on the chest. Often, patients also describe a feeling of constriction, or a feeling as if it takes all their energy to breathe. In general, if a patient is acutely aware of their breathing, they are likely suffering from dyspnea. To determine this for certain, a doctor may perform an x-ray, evaluate pulmonary mechanics, or administer a fitness exam.

Treatment for dyspnea can vary greatly, according to the underlying causes. One of the more basic treatments is climate control. For some patients, a fan blowing on the face or good ventilation with low humidity can alleviate some of the symptoms. For those patients who are bed-ridden, sometimes adjustment of position can ease breathing. For patients who are mobile, exercise can be of great benefit, increasing lung capacity to counteract the underlying cause of dyspnea. An adjustment in breathing techniques, such as having the patient breathe in slow, rhythmic patterns, can also help. Nutrition may have an effect on alleviating dyspnea. In the most extreme cases, intravenous methods may be employed to replenish nutrients. Supplementary oxygen may also be used, administered either through a mask or nasal prongs.

Doctors may also prescribe a variety of drugs to help with dyspnea. Opiates like morphine have been found to be effective, especially in cancer patients who may be suffering from chronic pain. Generally, however, a lower dose of opiate is required to alleviate dyspnea than is required to treat pain. Although morphine is the most commonly prescribed drug, most opioids have been used effectively.

Additionally, anti-inflammatory drugs can be helpful in assisting breathing. Cancers that affect the air passageways can cause inflammation that restricts breathing. Anti-inflammatory drugs, including steroids, can help open air passages, making breathing easier and less laborious. Anti-anxiety drugs are used for treatment as well, as anxiety is often an underlying cause of dyspnea. Patients who are going through the traumatic experience of cancer may have an increased risk of dyspnea, due to both the effect of cancer and the corresponding anxiety that often accompanies those who are facing life-threatening disease. Some patients have also experienced improvement using methods such as Yoga or acupuncture.

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