Breathlessness is the most common symptom of pleural mesothelioma and is often caused by a build-up of pleural fluid around the lungs. In the earlier stages of pleural mesothelioma, controlling this fluid build-up will improve breathlessness. The level of improvement will depend on how healthy your lungs were before you developed pleural mesothelioma, and the level of lung function after surgery. You may also feel breathless because of the cancer itself not allowing the lung to work properly – this is known as a trapped lung.

Infection or a low level of red blood cells (anaemia) can also cause breathlessness. Your doctor can manage this with medication.

Although living with breathlessness can be difficult, there are ways to reduce its impact on your life. For some people, there are surgical options to control the build-up of fluid.

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Ways to drain fluid around the lungs

You may have a procedure to drain the fluid from around the lungs. If you have gone to the doctor with symptoms, this may be done before mesothelioma is diagnosed. Sometimes it is done at the same time as the biopsy.

Pleural tap

Also known as pleurocentesis or thoracentesis, a pleural tap drains fluid from around the lungs. To drain the fluid, your doctor can numb the area with a local anaesthetic and insert a needle through the skin. An ultrasound scan is used to help the doctor guide the needle to where the fluid is. A pleural tap can also be done when a biopsy is taken during the keyhole surgery called VATS.

Ways to control fluid around the lungs

Talc pleurodesis

To prevent fluid building up again in the lining of the lungs, you may have a talc pleurodesis. This is best done when you are having a pleural tap during VATS, but may also be done under local anaesthetic by a respiratory physician.

Pleurodesis means closing the pleural space. The doctor inserts sterile talcum powder (talc slurry) into the pleural cavity. The talc slurry causes an inflammatory reaction that helps to fuse the two layers of the pleura together. After pleurodesis, some people experience a burning pain in the chest for 24–48 hours. This pain can be eased with medication.

Talc pleurodesis is sometimes done during the process of diagnosing pleural mesothelioma. If you haven’t already had this procedure, your surgeon may suggest it now.

VATS with pleurectomy and pulmonary decortication

When fluid is drained and talc pleurodesis is done during VATS, some of the outer lining of the chest wall and lung may also be removed. This is known as parietal pleurectomy (because only the outer pleura is removed) and pulmonary decortication.

Open surgery (thoracotomy) with pleurectomy and pulmonary decortication

Following VATS and talc pleurodesis, the fluid build-up around the lungs may come back, making you feel breathless again. The surgeon may suggest more extensive surgery called thoracotomy with pleurectomy and pulmonary decortication. This surgery may also be recommended as a first option if the cancer has grown in a way that makes it
difficult to perform VATS successfully.

Under a general anaesthetic, the surgeon will open the chest by making a cut from the back to the side of the chest, and between the ribs. The pleural fluid is drained and the part of the pleura most affected with cancer is removed. In some cases, all of the pleura may be removed. After this procedure, the anaesthetist inflates the lung and the surgeon closes the chest. Tubes are left in place in the chest for at least 48 hours to drain blood and any air that is leaking from the surface of the lung.

Open surgery helps to prevent fluid building up again in most cases. It also makes it easier for the lungs to expand and to transfer oxygen to the blood. Pain can last longer than after VATS, but the improvement in symptoms may make open surgery a worthwhile option if VATS has been unsuccessful or isn’t possible.

Indwelling pleural catheter

Some people cannot have VATS or open surgery, either because they are too unwell or because the cancer has grown in a way that makes the surgery too difficult. In this case, you may be offered an indwelling pleural catheter (also known as a drain) to help your breathing. This can also be used if the pleural fluid builds up again after pleurodesis.

Under local anaesthetic, the specialist will insert a thin tube (the catheter) through the chest wall into the pleural cavity. You can manage the drain at home with the help of a community nurse, family member or friend. When you need to drain the fluid (usually once or twice a week), the catheter can be connected to a bottle.

Sometimes with an indwelling pleural catheter, the pleural cavity may close up over time and stop producing fluid. If this occurs, the drain will be removed.

Improving breathlessness at home

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. You may be able to use an oxygen concentrator at home to deliver oxygen to your lungs. For social outings and medical appointments, you can use a portable oxygen cylinder. 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 cool stream of air across your face if you experience breathlessness when you are not exerting yourself.

Explore options – Some people find breathing exercises, acupuncture and meditation helpful. Call 13 11 20 for more on this, or see Complementary Therapies.

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. In some states and territories, Cancer Council offers free relaxation CDs, or you can listen to them now.

As well as surgical options, there are a number of ways you can manage breathlessness at home. You can also watch Lung Foundation Australia’s video Managing your breathlessness, which you can watch at under “Self-management”.

This information was last reviewed in May 2017
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