How can I manage my shortness of breath?
Breathlessness (or dyspnoea) is the experience of fast or difficult breathing; the sensation that you are not able to get enough air into your lungs.
Some episodes of breathlessness have a clear trigger such as physical exertion (walking, climbing stairs or showering), certain positions (lying flat or on a particular side) or an emotional cause (feeling anxious or scared). Other times, breathlessness may come on without clear cause, while resting during the day or night.
Knowing what triggers your breathlessness is important. You may wish to document your shortness of breath (on the symptoms section of this app) to help recognise any patterns or triggers. Once you know what may cause your difficult breathing, you can take steps to prevent it getting worse. You may be able to adapt a task (by sitting down or by breaking it into smaller tasks) or adopt different positions that can help (if sleeping flat causes shortness of breath, sleeping in a more upright position may help).
Breathing is not something we are usually conscious of. When you feel breathless, you may feel very aware of your breathing, leading to discomfort or panic. Anxiety and breathlessness are closely linked (each can cause the other) making it difficult to differentiate between the two. Talking openly about your experience with breathlessness with loved ones and healthcare professions, can help you find ways of coping [1].
When you are having a breathlessness episode, it is important to have techniques that you can use to help regain breathing control. The four Fs is a good place to start!
Fan Therapy
Opening a window or using a fan can help create a flow of air, which can be very helpful when feeling breathlessness. Research has found that pointing a handheld fan between your eyes can slow your breathing rate by stimulating a nerve on the side of your face (trigeminal nerve).[2]
Flop
When we feel anxious, the body can become tense and rigid. Aim to relax your muscles as much as possible, particularly your shoulders to optimise your breathing position. It can help to use a chair if possible, to support your body.
Forward Lean
Sitting or standing upright and leaning forwards with your arms resting on a surface, is often the best position for someone feeling breathless. You may wish to lean onto your thighs, a table, lying with your head on a pillow or standing with your arms against a wall. For some people, they may prefer to be lying down or resting with their back to a wall. The important thing is that it works for you.
Focus on your out breath
When we feel breathless, we often take increased short, shallow breaths: this is called over-breathing or hyperventilating. This can lead to an unbalanced exchange of oxygen and carbon dioxide, which can create a vicious cycle of feeling breathless. To counterbalance this, we slow down our breathing rate by taking a deep breath in through the nose and a long breath out through the mouth. The out-breath (exhalation) should be longer than the in-breath (inhalation). It can be helpful to follow the outline of a rectangular object, such as a TV or a frame, breathing in on the short side and out on the long side, to get the right ratio.
Remember it will pass
Remind yourself that you have experienced this before, and you are okay. It can be helpful to have someone to reassure you through these episodes or alternatively, you may wish to pre-record a voice-message to coach yourself through.
If you need support, do not hesitate to reach out to a healthcare professional with appropriate experience, such as an oncology physiotherapist, nurse or your doctors.
August 2022
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Ms Hannah Leach has no disclosures to report.
References
[1] Hutchinson, A et al. Living with breathlessness: a systematic literature review and qualitative synthesis. European Respiratory Journal 2018; 51(2): 1701477.
[2] Puspawati NLPD et al. Hand-held Fan Airflow Stimulation Relieves Dyspnea in Lung Cancer Patients. Asia Pac J Oncol Nurs. 2017; 4(2): 162-167.