Breathlessness and coughing in palliative care Hēmanawa me maremare ki te manaakitanga whakamaene

Several things can cause breathlessness or coughing, including:

• lung issues, such as chronic obstructive pulmonary disease (COPD), asthma or inflammation in your lungs caused by radiation treatment
• heart problems, such as heart failure or fluid around your heart
• problems in your blood, such as anaemia or an infection
• problems with the nerves and muscles you use to breathe
• cancer – the cancer itself, a tumour blocking your airways, fluid caused by the cancer building up around your lungs, or similar issues
• a chest infection
• anxiety.

Breathlessness can feel like:

• a tightness in your chest
• you cannot get enough air when you breathe in
• you are having to work hard to take a breath
• it is stopping you from moving or talking.

Coughing can happen with other symptoms such as wheezing, breathing or a tight chest.

Breathlessness and coughing can interfere with your:

• sleeping
• eating
• drinking
• talking.

Breathlessness and coughing can be worrying and cause you distress. If your breathlessness cannot be medically treated, your healthcare provider will check how anxious it is making you. They will also check how it is affecting your day-to-day life. There are a number of treatment options to help manage your breathing.

If breathlessness or coughing is worrying you, see your healthcare provider. There may be treatments that can help. These could include:

• a change to your medications
• chemotherapy
• radiotherapy.

Medicines

There are several medicines that your healthcare provider might try to treat your shortness of breath or cough.

• Medicines given through a nebuliser, such as salbutamol or saline.
• Low doses of morphine.
• Steroids such as prednisone.
• Some anti-anxiety medicines for severe anxiety or panic — these are usually reserved for people who only have a short time to live as they can make you sleepy.
• Oxygen for people who have low oxygen levels. This needs to be approved and prescribed by a hospital specialist.
• Antibiotics for a cough.

Your healthcare provider may write you a breathlessness management plan. This is so you and your whānau know what to do and who to call if your usual strategies and medicines are not helping.

Non-medical treatment

If your breathlessness or coughing cannot be medically treated, your healthcare provider will need to check how anxious it is making you. They will also check how it is affecting your day-to-day life and how uncomfortable it is for you.

Treatment for breathing

Your healthcare provider may have options for managing your breathing that can help, including:

• relaxation techniques and mindfulness
• breathing control techniques, such as dropping your shoulders when you breathe out
• distraction techniques, such as listening to music
• changing the way you lie, sit or stand or changing your sleeping position during the night
• managing how much energy you use by using equipment such as a walking frame, or changing the way you do tasks, such as dressing in stages while sitting
• directing fresh air onto your face by sitting near an open door or window or blowing a fan across your face
• having frequent rest periods and pacing the tasks you do
• asking others to help with tasks around the home and not doing them all yourself
• doing simple exercises, such as straightening one leg at a time when sitting in a chair or practising sitting up and down to keep your leg muscles strong, which can help your breathing feel easier when you walk.

You can ask your healthcare provider for a referral to a physiotherapist, occupational therapist or counsellor if you need more advice.

Treatment for coughing

Things that can help reduce your coughing include:

• changing your position, particularly during the night
• steam inhalation or using a nebuliser with a saline solution
• chest physiotherapy
• sipping water
• a soothing cough syrup which you can buy from a pharmacy – ask your healthcare provider or pharmacist which one will be best for you.