Symptoms - Shortness of Breath

Reviewed by: HU Medical Review Board | Last reviewed: January 2017.

One of the most common symptoms of lung cancer, particularly in advanced stage lung cancer, is shortness of breath, also known as dyspnea. Estimates on how many lung cancer patients experience shortness of breath range from 55-90%.1,2

Difficulties breathing

Dyspnea is a distressing symptom, as patients feel like they are struggling for each breath, and it is strongly correlated with quality of life. One study demonstrated that patients rated their quality of life across physical, social, psychological, and global functioning progressively lower as the severity of dyspnea increased.1

Causes of shortness of breath

Dyspnea can be a direct result of lung cancer, a side effect of treatment, or not related to the cancer or treatment at all. In addition to lung cancer, patients may have other conditions associated with shortness of breath, such as chronic obstructive pulmonary disease (COPD), congestive heart failure, pleural effusion (fluid build-up in the chest cavity), air flow obstruction, or asthma.3

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Assessing dyspnea

Researchers have demonstrated that the amount of tumor involvement in the lungs and oxygen saturation (oxygen in the blood) levels do not necessarily match up with levels of dyspnea and these measurements are not appropriate objective measures for breathlessness in patients. A patient can have oxygen saturation greater than 90% and still experience shortness of breath. In addition, dyspnea appears to be related to physical causes as well as psychological distress and pain. Dyspnea can be caused by a variety of factors, which makes it challenging to treat.4

Shortness of breath is very subjective, and assessment tools for dyspnea focus on the patient’s perspective. There is no one standard for measuring dyspnea. There are a variety of scales used, many using a single-item numeric scale approach.1,4

Quality of life care

Experiencing shortness of breath is distressing, and dyspnea can become more common as lung cancer becomes more advanced. Palliative care is a specialized field that aims to alleviate symptoms and maximize the patient’s quality of life. Palliative care does not focus on curing the disease or prolonging life, which is the goal of other cancer treatments, such as chemotherapy. However, palliative care is an important part of the patient’s treatment plan and encompasses physical symptoms, psychosocial distress, spiritual distress, and caregiver distress.5

Treatment options

Ideally, the underlying causes of dyspnea are treated to relieve the symptom. In cases of pleural effusion, draining the excess fluid through thoracentesis (procedure to remove the fluid) can provide relief. Treatment of the underlying lung cancer may include surgery, chemotherapy or radiation therapy.

In addition, palliative care measures used in conjunction with lung cancer treatment include oxygen therapy, breathing techniques, opioids (pain medications), and anti-anxiety medications. Some patients have also found relief with complementary therapies such as acupuncture, acupressure, and relaxation techniques.1,4,5