Many people with lung cancer have difficulty breathing and shortness of breath (dyspnoea). This can be challenging and may cause distress.
Types of surgery that can help improve this symptom include:
- pleural tap to drain the fluid
- pleurodesis to stop fluid building up again
- indwelling pleural catheter to drain the fluid.
You may have one or more of these procedures to ease symptoms even before lung cancer is diagnosed, and they could be suggested at any time to improve breathlessness.
You may also be referred to a pulmonary rehabilitation course to learn about how to manage breathlessness, which will include exercise training, breathing techniques and tips for pacing yourself. Read some tips to manage breathlessness at home.
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For some people, fluid may build up in the space between the two layers of thin tissue covering the lung (pleural cavity). This is called pleural effusion and can put pressure on the lung, making it hard to breathe. A pleural tap can relieve this symptom. The procedure is also known as pleurocentesis or thoracentesis.
- To drain the fluid, your doctor or radiologist numbs the area with a local anaesthetic and inserts a hollow needle between your ribs into the pleural cavity.
- The fluid can then be drained, which will take about 30-60 minutes.
- You don’t usually have to stay overnight after a pleural tap.
- A sample of the fluid is sent to a laboratory for testing.
Pleurodesis means closing the pleural cavity. Your doctors might recommend this procedure if the fluid builds up again after you have had a pleural tap. It may be done by a thoracic surgeon or respiratory physician in one of two ways, depending on how well you are and your preferences:
This method uses a type of keyhole surgery called video-assisted thoracoscopic surgery (VATS).
- You will be given a general anaesthetic, then a tiny video camera and operating instruments will be inserted through small cuts in the chest.
- After all fluid has been drained, the surgeon then puffs some sterile talcum powder into the pleural cavity. This causes inflammation that helps fuse the two layers of the pleura together and prevents fluid from building up again.
Bedside talc slurry pleurodesis
If you are unable to have a general anaesthetic, a pleurodesis can be done under local anaesthetic while you’re in bed.
- A small cut is made in the chest, then a tube is inserted into the pleural cavity.
- Fluid can be drained through the tube into a bottle.
- Next, talcum powder mixed with salt water (a “slurry”) is injected through the tube into the pleural cavity.
- To help distribute the talc slurry throughout the pleural cavity, nurses will help you move into various positions for about 10 minutes at a time.
- The entire process takes about an hour.
Pleurodesis usually requires a hospital stay of two or three days. After the procedure, some people experience a burning pain in the chest for 24âˆ’48 hours, but this can be eased with medicines.
An indwelling pleural catheter is a small tube used to drain fluid from around the lungs. It may be offered to people who repeatedly experience a build-up of fluid in the pleural cavity that makes it hard to breathe and who are unable to or prefer not to have pleurodesis.
- Using local anaesthetic, the doctor inserts the catheter through the chest wall into the pleural cavity. One end of the tube remains inside the chest, and a small length remains outside the body for drainage. This end is coiled and tucked under a small dressing.
- When fluid builds up and needs to be drained (usually once or twice a week), the end of the catheter is connected to a small bottle.
- You can manage the catheter at home with the help of a community nurse. Your family or a friend can also be taught how to clear the drain.
Now I have good and bad days. I do breathing exercises during rehabilitation. Sometimes I feel so good that I overdo it. I forget that I have one lung and I tire easily. I’m learning to pace myself.
It can be distressing to feel short of breath, but a range of simple strategies and treatments can provide some relief at home.
Treat other conditions
Let your doctor know if you feel breathless. Other conditions, such as anaemia or a lung infection, may also make you feel short of breath, and these can often be treated.
Sleep in a chair
Use a recliner chair to help you sleep in a more upright position.
Ask about medicines
Talk to your doctor about medicines, such as a low dose of morphine, to manage feelings of distress. Make sure your chest pain is well controlled, as pain may stop you breathing deeply.
Check if equipment could help
Ask your health care team about equipment to manage breathlessness.
- To improve the capacity of your lungs, you can blow into a device called an incentive spirometer.
- You may be able to use an oxygen concentrator at home to deliver oxygen to your lungs, or a portable oxygen cylinder for outings.
- If you have a cough or wheeze, you may benefit from a nebuliser, a device that delivers medicine into your lungs.
Modify your movement
Some types of gentle exercise can help, but check with your doctor first. A physiotherapist, exercise physiologist and/or occupational therapist from your treatment centre can explain how to modify your activities to improve breathlessness.
Relax on a pillow
Lean forward on a table with an arm crossed over a pillow to allow your breathing muscles to relax.
Create a breeze
Use a fan to direct a stream of air across your face if you feel short of breath. Sitting by an open window may also help.
Find ways to relax
Listen to a relaxation recording or learn other ways to relax. This can allow you to control anxiety and breathe more easily. You can listen to our free relaxation and meditation audio tracks now. Some people find breathing exercises, acupuncture and meditation helpful.
For more on this, call 13 11 20 or see Complementary therapies.
Dr Henry Marshall, Thoracic Physician, The University of Queensland Thoracic Research Centre, The Prince Charles Hospital, QLD; Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Melbourne and Epworth Richmond Hospitals, VIC; A/Prof Martin Borg, Radiation Oncologist, GenesisCare, SA; Dr Lisa Briggs, Consumer; Kirsten Mooney, Thoracic Cancer Nurse Coordinator, WA Cancer & Palliative Care Network, WA; Claire Mulvihill, Lung Cancer Support Nurse, Lung Foundation Australia; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Nick Pavlakis, President, Australasian Lung Cancer Trials Group, President Elect, Clinical Oncology Society of Australia, and Senior Staff Specialist, Department of Medical Oncology, Royal North Shore Hospital, NSW. We also thank the health professionals, consumers and editorial teams who have worked on previous editions of this title.
View the Cancer Council NSW editorial policy.
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