Many people with lung cancer have difficulty breathing and shortness of breath (dyspnoea) before or after diagnosis.
Learn more about:
- What causes it?
- How breathlessness is managed
- Having a pleural tap
- Indwelling pleural catheter
- Improving breathlessness at home
What causes it?
Difficulty breathing and shortness of breath (dyspnoea) can occur for several reasons, such as the cancer itself and a reduction in lung function, a decrease in fitness level due to reduced physical activity or a build-up of fluid between the linings of the lung (pleural effusion).
How breathlessness is managed
If breathlessness is caused by fluid build-up in the pleural cavity (the space between the linings of the lung), you may need to have surgery:
- pleural tap to drain the fluid
- pleurodesis to stop fluid building up again
- indwelling pleural catheter to drain the fluid.
If the cancer is blocking one of the main airways, a doctor may be able to use a laser to open up the airway and improve breathing.
You may also be referred to a pulmonary rehabilitation course to learn how to manage breathlessness. This will include exercise training, breathing techniques, ways to clear the airways, and tips for pacing yourself.
For some people, fluid may build up in the space between the two layers of thin tissue covering the lung. This is called pleural effusion and it can put pressure on the lung, making it hard to breathe.
Having 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 usually don’t have to stay overnight in hospital 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 what you would prefer:
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 one or more 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. You will stay in hospital for a few days.
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, sterile talcum powder mixed with salt water (a “slurry”) is injected through the tube into the pleural cavity.
- To help move 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.
A slurry pleurodesis usually requires a hospital stay of two or three days. After the procedure, some people experience a burning pain in the chest for 24–48 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.
- You will be given a local anaesthetic, then the doctor inserts the catheter through the chest wall into the pleural cavity. One end of the tube is inside the chest, and the other stays 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. A family or 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.Lois
It can be distressing to feel short of breath, but a range of simple strategies can provide some relief at home.
Treat other conditionsLet 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 more uprightUse a recliner chair or prop yourself up in bed to help you sleep in a more upright position.
Ask about medicinesTalk to your doctor about medicines, such as a low dose of morphine, to ease breathlessness. Make sure your chest pain is well controlled, as pain may stop you breathing deeply.
Check if equipment could helpAsk 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 movementSome types of gentle exercise can help but check with your doctor first. A physiotherapist, exercise physiologist or occupational therapist from your treatment centre can explain how to modify your activities to improve breathlessness.
Relax on a pillowLean forward on a table with an arm crossed over a pillow to allow your breathing muscles to relax.
Create a breezeUse a handheld fan to direct a cool stream of air across your face if you feel short of breath when not exerting yourself. Sitting by an open window may also help.
Find ways to relaxListen to a relaxation recording or learn other ways to relax. This can allow you to control anxiety and breathe more easily. Listen to our 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.
Podcast: Coping with a Cancer Diagnosis
A/Prof Nick Pavlakis, President, Australasian Lung Cancer Trials Group, President, Clinical Oncology Society of Australia, and Senior Staff Specialist, Department of Medical Oncology, Royal North Shore Hospital, NSW; Dr Naveed Alam, Thoracic Surgeon, St Vincent’s Private Hospital Melbourne, VIC; Prof Kwun Fong, Thoracic and Sleep Physician and Director, UQ Thoracic Research Centre, The Prince Charles Hospital, and Professor of Medicine, The University of Queensland, QLD; Renae Grundy, Clinical Nurse Consultant – Lung, Royal Hobart Hospital, TAS; A/Prof Brian Le, Director, Palliative Care, Victorian Comprehensive Cancer Centre – Peter MacCallum Cancer Centre and The Royal Melbourne Hospital, and The University Of Melbourne, VIC; A/Prof Margot Lehman, Senior Radiation Oncologist and Director, Radiation Oncology, Princess Alexandra Hospital, QLD; Susana Lloyd, Consumer; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; Nicole Parkinson, Lung Cancer Support Nurse, Lung Foundation Australia.
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