Breathing problems and metastatic breast cancer

Being short of breath can be frightening and exhausting. Shortness of breath also is frustrating when it limits your activity.

Breathlessness does not always mean your cancer is getting worse. It is important, though, to let your doctor know as soon as possible so they can find the cause and provide the right treatment.

The medical name is dyspnoea (pronounced ‘dis-nee-a’).

What can cause shortness of breath

In addition to cancer deposits in the lung, other causes of shortness of breath can be:

• a build-up of fluid around the lungs, in the pleural cavity (‘pleural effusion’)
• chest infection
• low red blood cells
• a blood clot in the the lung (‘pulmonary embolus’)
• breast cancer cells blocking lymph channels in the lungs (‘lymphangitis’), which causes inflammation and scarring of the tissue
• scarring of the lungs from previous radiotherapy
• a swollen abdomen causing pressure under the diaphragm
• pre-existing lung problems such as asthma or emphysema
• pain, anxiety or fear.

Ways to treat or relieve breathlessness

It’s best to discuss any feelings of breathlessness with your doctor or nurse as soon as possible. They can investigate the cause and suggest the appropriate treatment and care. Investigations might include blood tests and a chest X-ray.

Medical treatments

• a blood transfusion for low red blood cells
• drainage of any fluid that has built up
• medications such as diuretics, steroids, blood thinners and antibiotics
• a small dose of morphine – sometimes this can be inhaled through a nebuliser with good results
• oxygen – your doctor or palliative care team can arrange for you to have an oxygen supply at home
• treatment of the cancer
• treatment for anxiety or pain.

Palliative care teams are skilled in managing breathlessness and can coordinate the appropriate care for you.

For severe or ongoing anxiety, medication can be helpful. You can discuss this with your doctor. It is also important to manage any pain, fatigue or sleep issues, as these can make anxiety worse.

If it hurts to breathe deeply or to cough, you will likely try to avoid doing both. This could cause mucus ('secretions') to gather in your chest and restrict your breathing.

Ways to help shortness of breath without medications

You may also find these strategies helpful to relieve breathlessness:

• Try sleeping sitting up, supported by pillows.
• Take things slowly and try to focus on what you can do rather than becoming frustrated about what you can’t do.
• Try to keep as active as possible to maintain physical strength and wellbeing.
• Open the window or use a fan to create a sense of airflow in the room.
• Ask your doctor if a physiotherapist might be able to help with breathing techniques and exercises such pursed-lip breathing ( 'purse' your lips as if you were going to whistle).
• Try relaxation, meditation and mindfulness, which can help reduce feelings of anxiety.

A psychologist, physiotherapist or cancer care nurse will be able to help you with relaxation and breathing exercises.