How To Manage Your Shortness Of Breath

How to Manage YourShor tnessof BreathThis patient guide will help you understand:What is cancer-related shortness of breath?pg 2What causes shortness of breath?pg 4What can I do to manage my shortness of breath?pg 5When should I talk to my health care team aboutmy shortness of breath?pg 12Where can I get more information?pg 14This guide is for people who have shortness of breathbefore, during or after cancer treatment. It can be used bypatients, family, friends or caregivers. It does not replaceadvice from your health care team.Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.caThis information is to be used for informational purposes only and is not intended as a substitute for professionalmedical advice, diagnosis or treatment. Please consult your health care provider for advice about a specificmedical condition. A single copy of these materials may be reprinted for non-commercial personal use only.Author: Cancer Care Ontario Reviewed: 2019 Form: D-8616

What isshortness of breath?Shortness of breath is thefeeling of not having enough airto breathe.Feeling short of breath can bescary and can affect your normalday to day activities.It can also be an uncomfortablefeeling while you are breathing.You can have shortness of breathwhen resting or when you aredoing something physical, nomatter how small the activity.People with shortness of breath often say they feel:AnxiousPanickyFrightenedVery breathlessNervous2

WHAT IS SHOR TNESS OF BREATH?What happens duringShortness of Breath?Your breathing gets shallower andfaster and you may feel like you donot get as much oxygen fromyour breaths.Your muscles then begin to tenseand you start to feel nervous todo things.The fear of not being able tobreathe makes your shortness ofbreath worse.Shortness ofbreathGetting moreanxiousShallowbreathingTense musclesLimiting youractivitiesWorse shortnessof breathGetting anxious3

What causesshortness of breath?It is important to find the treatable causes that may bemaking your shortness of breath worse.This picture shows things that can causeshortness of breath:Muscle weaknessBlood clotBlockage inyour airwayLow oxygenlevelsSmokingCauses ofshortness ofbreathAnxiety anddepressionSide effectsfrom treatment4Low bloodcountFluid aroundthe lung (pleuraleffusion)Lung diseaselike COPD oremphysemaInfection, likepneumonia

What can I do to managemy shortness of breath?Learn breathing exercises and positionsBreathing exercises can be helpful, especially if youhave severe shortness of breath.Abdominal breathingRecovery breathingThis type of breathing can help yourecover from feeling breathlessafter an activity.Use this exercise any timeyou feel very breathless orpanicky.Follow these steps:Follow these steps:1. Relax your shoulders.1. Use one of the positionsfrom page 6.2. Place one hand on yourabdomen (belly) just belowyour chest.3. Count 1, 2, 3, 4, as you take abreath in and feel yourabdomen rise slowly.4. Breathe out slowly with pursedlips (like you are whistling orblowing out a candle) as youcount 5, 6, 7, 8, 9, 10.5. Repeat this 3 – 4 times.Practice this 3 times a dayand before and after doingan activity.2. Drop your chin.3. Breathe in and out whilefocusing on your breath.4. Purse your lips.5. Little by little, blow out forlonger periods.6. Once your breathing slowsdown, sit up straight and do 2or 3 more abdominal breaths.7. Rest for a few minutes beforestarting your activities again.Tip:You can practice recoverybreathing while sitting,standing, or lying down.5

WHAT CAN I DO TO MANAGE MY SHOR TNESS OF BREATH?Positions to help you breathe easier and relaxStanding: Lean against a wall,with your chin slightly droppedtowards your chest. Your shouldersshould be relaxed and your armshanging loosely by your sides.Sitting: Sit and lean forward. Restyour forearms on your thighs withyour wrists relaxed and your feeton the floor.6Laying down: Make a slope with afoam wedge in between your boxspring and mattress or with threeor four pillows stacked up. Laydown on your side with pillowssupporting you so that your headis higher than your legs.

WHAT CAN I DO TO MANAGE MY SHOR TNESS OF BREATH?Do relaxation exercisesRelaxing can help you to slow your breathingand make your breaths more effective.Follow these steps:1. Find a comfortable position.2. Relax or close your eyes.3. Now breathe gently.4. Try to think of somethingpleasant and create a picture inyour mind.Videos on breathing andrelaxation can be found at:www.youtube.com/user/ManagingSOB5. You may like to listen to musicto help you relax.7

WHAT CAN I DO TO MANAGE MY SHOR TNESS OF BREATH?Make lifestyle changesTake your medications asprescribedDo things in ways that use lessenergyThere are some medications thatcan help shortness of breath.Sit down when doing chores andgetting dressed.You may need oxygen if youroxygen level is low. Your healthcare team will test your levels ifyou are having shortness of breath.Rest as much as you need to.Pace yourselfBreak your activities down intosmaller steps.Plan your activities so that youhave time to do them slowly andcomfortably.Keep things that you use oftenclose by and within easy reach.Avoid heavy lifting. Carry things atyour waist or hold them close toyour chest. Use a backpack to carrythings and only fill bags half-way.Keep your phone close by andstop to catch your breath whenyou are having a conversation.A standing or sitting position maybe more comfortable duringsexual activity with your partner.Share your feelingsShortness of breath can make youfeel worried and anxious. Shareyour feelings with family, friendsand your health care team.8

WHAT CAN I DO TO MANAGE MY SHOR TNESS OF BREATH?Be activeEven if you have severe lungproblems, you can do smallamounts of exercise.Use abdominal breathingwhen walking up slopes,climbing stairs or standing up.To climb stairs:Take it slowly and use abdominalbreathing as much as possible.Stand close to the stairs with onehand on the railing beside you.Increase the amount of exerciseyou do little by little to improveyour breathing and feel better.Breathe in as you lift your leg up.Showering or bathingKeep the bath water shallowand lukewarm.Open a window in the bathroomto let in fresh air and let out steam.Sit in the shower.Position the shower water awayfrom your face.Breathe out as you place your legon the step and raise yourself up.Change the way you eatChew your food slowly, takingbreaks in between bites.Try smaller meals more often.If you are having trouble eating,ask your health care team abouttrying nutrition drinks.Rest when you need to.9

WHAT CAN I DO TO MANAGE MY SHOR TNESS OF BREATH?Use devices to help you saveyour energySome devices can help to cut down onthe work your body needs to do in orderto breath.Use pillows to raise your headwhen lying down.Ask about using a bedrail, bathboard, or other safety equipment.Use a reclining chair with afootrest when sitting.Try using a cool fan across yourface to breathe easier.Use a walker or wheelchair if youneed them.Change your environmentAvoid things that can causeshortness of breath like smoking,perfume, flowers and pets.Open a window or use a fan to getfresh air if the weather is good.10Stay inside when the weather isvery hot or cold.

WHAT CAN I DO TO MANAGE MY SHOR TNESS OF BREATH?Quit smokingSmoking can make your shortness ofbreath worse.Your pharmacist or family doctor can help you make a plan to quitsmoking. They can:Suggest nicotine replacements(like the patch or gum)Help you keep track of yourprogressPrescribe medication to helpyou quitQuitting smoking is the best decision you can make,but quitting is hard. Here are some resources to help you: Smokers Helpline, Canadian Cancer Societywww.smokershelpline.ca Quit Smokinghttp://www.quitsmoking.com11

When should Italk to my health care team?Tell your health care team right away if you have anyof these symptoms:Breathing that has become harderover a short period of time.You are struggling to breathe andfeel very nervous.A sharp pain when you cough ortake a deep breath.A fever of 38.3 C (100.9 F) or higherat any time or 38.0 C (100.4 F) orhigher for at least one hour.A new cough or one that isgetting worse.Noisy breathing.Call 911 or go to your nearest emergency departmentif you ever have:Breathing problems with dizziness,an increased heart rate or verypale skin.Sudden shortness of breath whenyou wake up.A sudden, new or increasingchest pain.What is symptom screening?In Ontario, patients with cancerfill out a symptom screening tool.The screen tells your health careteam about your symptoms andhow you are feeling. The tool iscalled the Edmonton SymptomAssessment System (ESAS).12Doing your symptomscreening helps you andyour health care team tomanage your symptoms.

WHEN SHOULD I TALK TO MY HEALTH CARE TEAM?Use the boxes below to help your healthcare team understand your symptom.0 is no shortness of breath and 10 is the worst shortness of breath.0-34-67-10You may haveMild shortness ofbreath if:You may haveModerate shortness ofbreath if:You may haveSevere shortness ofbreath if:You can usually sit andlie quietlyYou feel it almost all thetimeIt comes on quickly orhas gotten much worseIt comes and goesYou have new orworsening shortness ofbreathYou almost always feelanxiousIt gets worse withactivityYou have no anxiety ormild anxiety whilefeeling short of breathIt is not hard to breathYour shortness ofbreath gets worse withactivity and only settlesa little bit with restIt is somewhat hard tobreatheBreathing is always hardYou wake up suddenlyfeeling short of breathYour shortness of breathmakes it hard for you totalk or have aconversationYour health care team wants to know about yourshortness of breath. Your questions and concerns areimportant. Do not be afraid to share them.13

Where can I get moreinformation?For links to these and other helpful resources go ncer Care Ontariowww.cancercare.on.caManaging Shortness of Breath,a series of videoswww.youtube.com/user/ManagingSOBCanadian Cancer Societywww.cancer.ca1-888-939-3333Support services:Canadian Cancer SocietyPeer Support Servicewww.cancer.ca/supportCancer Chat Canadawww.cancerchatcanada.ca14

WHERE CAN I GE T MORE INFORMATION?Ask your health care team for more informationabout managing shortness of breath.Pamphlets:Books:Videos:Classes:Local support groups:Ask your health care team who you should contactif you feel that your shortness of breath is so bad thatyou need help right away.15

This patient guide was adapted from Cancer Care Ontario’s “How to Manage Your Shortness of Breath”booklet. The recommendations in this guide are based on published evidence and expert consensus.The information in this guide was adapted from the following patient tools: Managing your Breathing(Trillium Health Partners) Getting the Air You Need(Juravinski Cancer Centre)This patient guide was created by Cancer Care Ontario to provide patients with information aboutshortness of breath. It should be used for information only and does not replace medical advice. Thisguide does not include all information available about managing shortness of breath. Always ask yourhealth care team if you have questions or concerns. The information in this guide does not create aphysician-patient relationship between Cancer Care Ontario and you.Need this information in an accessible format?1-855-460-2647 TTY 416-217-1815 publicaffairs@cancercare.on.caFor other patient guides please go to:www.cancercare.on.ca/symptomsWas this patient guide helpful? Let us know at: cco.fluidsurveys.com/s/guides/Version 1 – 2016Cancer Care Ontario retains all copyright, trademark and all other rights in the guide, including all text and graphicimages. No portion of this Resource may be used or reproduced, other than for personal use, or distributed,transmitted or "mirrored" in any form, or by any means, without the prior written permission of Cancer Care Ontario.

You feel it almost all the time You have new or worsening shortness of breath Your shortness of breath gets worse with activity and only settles a little bit with rest It is somewhat hard to breathe. 7-10. You may have . Severe. shortness of breath if: It comes on quickly or has gotten much worse You almost always feel anxious Breathing is .