Breathlessness

Symptoms can range from mild shortness of breath to very fast gasping breaths. You may also feel:

• dizzy
• chest discomfort and/or tightness
• anxious or scared.

If you have an underlying lung condition that makes you breathless from time to time, such as asthma or COPD, use your reliever inhaler immediately and follow the action plan written by your doctor or nurse. Read more about asthma and COPD.

If your breathlessness has come on slowly and has been happening for more than a month, it is a good idea to see your GP and get checked to make sure it is nothing serious.

What does breathlessness feel like?

If you are a carer of a person with breathlessness, you can understand what breathlessness feels like by trying one of the following activities to find out what breathlessness can feel like:

• Take a deep breath in and then breathe out half way. Then breathe in again. Now breathe at that level for a few more breaths. 
• Take a deep breath in and hold it as long as you can. 

Imagine you had to go up some stairs breathing like that. This is what breathlessness can feel like. 

There are many causes of breathlessness. It may come and go quickly (acute) or may come on slowly and last longer (chronic).

Acute causes include the following:

• Asthma – a respiratory condition that can cause wheezing and difficulty breathing. An acute attack may be triggered by a chest infection or hay fever.
• COPD – a long-term condition that causes breathlessness and cough. Symptoms made worse by chest infections.
• Pneumonia (a severe chest infection) will cause breathlessness.
• Pneumothorax (a collapsed lung).
• Pulmonary embolism (blood clot in your lung).
• Pulmonary oedema (fluid inside your lungs).
• A heart problem such as heart attack or heart failure where your heart doesn’t pump properly.
• Anxiety can cause breathlessness, rapid heartbeat (palpitations), sweating and feelings of panic.

Chronic causes include the following:

• COPD – a respiratory condition usually caused by smoking.
• Asthma that is not well controlled.
• Other lung conditions like bronchiectasis.
• Heart failure – breathlessness and swollen ankles gradually worsen.
• Heart rhythm problems, such as atrial fibrillation – this means blood isn’t pumped around your body properly so breathing becomes more rapid to try and get more oxygen into your lungs.
• Anaemia (low iron levels in your blood) – this means there is not enough haemoglobin in your blood to transport sufficient oxygen around your body.
• Being obese or not very fit.

How is breathlessness diagnosed?

To diagnose the underlying cause of your breathlessness, your doctor may ask you about the following:

• How often it happens, how quickly it comes on and how long it lasts.
• If anything causes you to become breathless or makes it worse.
• If it happens at rest or with activity.
• If you can sleep flat at night or if it gets worse lying down.
• If you been unwell with a fever.
• If you have been coughing any mucus or have any discomfort in your chest.

If you are known to have a condition that causes breathlessness, your doctor will review your medications and/or inhalers. They may ask you how you have been using them. Your doctor or nurse may explain how to use them to make sure they are working well.

Your doctor may also listen to your heart and lungs. If the cause of your breathlessness is not obvious from your history and examination, your doctor may talk to you about having some tests. These include:

• blood tests
• chest x-ray
• spirometry
• ECG or electrocardiogram.

How is breathlessness treated?            

Treatment will depend on what is causing your breathlessness. Your doctor may give you medication. This may be to treat pneumonia or other chest infection, wheezing, fluid build-up in your lungs or anxiety.

If you are a smoker, you will be strongly encouraged to stop. Losing weight if you are overweight will also help.

There are a number of things you can try to help manage breathlessness. 

Breath control techniques

There are some breathing techniques and exercises that can help you control your breathing.

A simple breathing exercise to try is as follows:

• Breathe in slowly for a count of 3 1-2-3.
• Hold your breath for a count of 3 1-2-3.
• Breathe out slowly for a count of 3 1-2-3.
• Repeat 3 or 4 times until you start to feel relaxed.

Ask your doctor about referring you to a physiotherapist to learn about breathing techniques and exercises. You can also look for a physiotherapist with a respiratory interest: Find a physio(external link) (Physiotherapy NZ). 

Body position

Changing the position of your body can also help when you are feeling breathless. Try the following:

• Put yourself in a position that supports your head and shoulders to relax comfortably.
• Try a range of positions such as sitting or standing up tall, or leaning forward resting your elbows on your knees or a bench.
• Rest, breathing slowly and gently, in the position that is most comfortable for you.

Relaxation and mindfulness exercises

Learning how to relax can help prevent the breathlessness/anxiety loop.

• Feeling breathless can make you feel anxious and when you are anxious, your breathing tends to become more rapid and shallow.
• This can make your feel more breathless, which in turn can increase your anxiety.
• Learning and practising relaxation techniques can help you become calm and slow your breathing.
• Mindfulness is a useful practice that can help you feel more relaxed and calm. Read more about mindfulness.

What can I do when the person I am caring for is breathless?

Not everyone wants help from carers when they are breathless. Sometimes, they just want to be given some space to get better on their own. Some people may find it useful if their carer says encouraging and reassuring things.

Tips for managing breathlessness

Here are some key steps you can do if someone you are taking care of is out of breath:

• Encourage recovery breathing by asking the person to find a comfortable position, then relax their shoulders and gently breathe out. They can also try breathing in from their stomach.
• Ask the person to work out what helps them to manage breathlessness by comparing the recent episode of breathlessness with the previous one. They can rate how breathless they felt on a scale of 0–10 (0 being not breathless at all and 10 being the worst breathlessness). 
• Agree on hand signs or signals with the person when they are not breathless so you can communicate with them when they are out of breath and can't speak. 
• Use a handheld fan to cool the person's face. Cool air can reduce breathlessness by calming down the patient. 
• Help them learn how to relax, as this can help prevent the breathlessness–anxiety loop. 
• Help them to use their inhaler when they are out of breath (if they have one). 
• Try acupressure, which involves stroking down either one of the person's arms all the way to the end of their thumb using the palm of your hand. Rubbing the top-middle of their back also helps. 

There are other strategies that are specific to conditions the person you are caring may have. Read more about understanding breathlessness in COPD(external link) and cancer(external link). 

Apps reviewed by Healthify

You may find it useful to look at some Anxiety management apps, Breathing apps, Meditation and mindfulness apps, COPD apps, Heart failure apps and Nutrition, exercise and weight management apps.

For myself

Breathlessness can’t always be prevented but some things might help.

• If you smoke, get help to stop.
• If you are overweight, try to lose weight.
• Exercise regularly. Even if you have a lung condition, exercise and pulmonary rehabilitation can help. It strengthens your muscles and helps you manage your daily activities. Being fit also improves your heart and lungs function, which helps to provide your body with the oxygen it needs. If you are struggling to exercise due to breathlessness, talk to your doctor as there may be an exercise/rehabilitation programme you can be referred to (depending on health condition). Read about pulmonary rehabilitation and green prescriptions.
• If you are on medication for your breathing, make sure you take it as prescribed. If you are still getting symptoms see your doctor for a medication review.
• Practice mindfulness and relaxation techniques.

For someone I care for

There are steps you can take to help reduce how often the person you care for is breathless.

Manage stress, panic and breathlessness

It is common for someone you are taking care of to feel upset and frightened when he or she is out of breath. As a carer, you may also feel the same. 

Breathlessness can be triggered by:

• certain activity such as getting washed or dressed
• hot or cold environment, aerosols or dust
• infections
• emotions such as feeling stressed or upset.  

Sometimes, there is no obvious trigger. 

If the person you are caring for is feeling stressed, that can worsen the breathlessness. The stress and breathlessness can feed each other in an unhelpful cycle(external link). 

Stress is a normal feeling we all have from time to time. It is your body's response to threat with a combination of worrying thoughts, feelings and emotions plus a range of bodily changes such as tight muscles, rapid breathing and increased heart beat. 

As a carer, you can't take away the stress from people, but you can help by exploring ways to help manage stress levels. Read more about stress, panic and breathlessness(external link) and managing stress. 

Help them to keep active

Before starting any exercise programme, it is best to get advice from a healthcare provider who understands the condition of the person with breathlessness. Keeping active can help strengthen muscles and help manage daily activities, including helping them to boost recovery after infections. Being fit also improves heart and lung function, which helps to provide the body with the oxygen it needs.

You can help by encouraging the person with breathlessness to attend an exercise class designed for people living with the same condition. You can also try and help them to do some useful strengthening techniques(external link), which can be helpful to do at home when it is hard to get out. 

Live a fulfilling life together

Living with breathlessness can be challenging, but it is possible for you and someone you care for to live a fulfilling life. There are lots of activities you can do together or things you can do separately. Both of you can support each other to make things enjoyable. Read more about living a fulfilling life(external link).

Some of fun things you and the person you care for can do include:

• Tai Chi or yoga classes
• singing in a choir
• watching sports
• gentle walking groups. 

Talk to their healthcare provider to find out classes or events available around your area. Read about pulmonary rehabilitation for people with COPD.

Manage infections

Infection can be one of the triggers for breathlessness. Unfortunately, you can't stop infections from happening and some people get them more easily than others. Therefore it's important that you help the person you care for to keep an eye on the symptoms and signs of infection, so infections can be managed and treated in time.

Ways to help prevent or manage infections include to:

• be alert to changes in symptoms – don't just assume it's the illness getting worse
• ask the person's healthcare provider about a self-management plan and follow the plan when they are breathless (the plan will include what medication to take, who to contact if you are concerned and the next steps when they are out of breath)
• encourage the person you are caring for to attend a rehabilitation course – ask their healthcare provider about the courses available in your area
• bring in the person you are caring for to get his or her annual flu vaccination and pneumococcal vaccination
• both you and the person you care for wash your hands with hot water and soap or use hand gel often and avoid touching your eyes and nose
• eat a healthy diet with plenty of fresh fruits and vegetables
• keep active
• avoid visitors with coughs, colds or fever
• avoid breathing in smoke or places with smoke. 

Read more about managing infections(external link). 

Living with breathlessness can be frightening. It is also challenging to do things physically. Talk through your feelings with your family/whānau and friends to get the support you need.

Below are some support services and information for people affected by breathlessness and their family/whānau:

Support groups for people with a respiratory condition(external link)(external link) Asthma and Respiratory Foundation, NZ
Information about anxiety, depression and mindfulness(external link)(external link) Mental Health Foundation, NZ

It can be difficult to think and talk about the future, but doing this helps you and your carer for being better prepared. 

Talking about the future

Talking about the future helps be better prepared for the future. However, having these conversations is not always easy. 

It is also useful to talk about having an advanced directive or advance care plan, which can help you decide what to do if you become unwell. Read more about talking about the future with others(external link). 

For carers: common changes if the person you care for get sicker

As the condition of the person you care for progresses, you may notice changes in their symptoms and that they can be more difficult to manage. They may also need more support as the condition worsens. 

Some of the common changes that you may notice include:

• more breathlessness
• loss of appetite and weight loss
• pain
• tiredness
• difficulty sleeping
• having frequent infections
• more flare-ups, wheezing, chest tightness, phlegm in COPD.

If you are unsure or having difficulties managing any symptoms of someone you care for, talk to their healthcare provider. Sometimes, it may be recommended that they have a respite stay. 

For carers: ways to cope with these changes

It may be hard for you to see how things change and how someone you care for gets sicker on a daily basis. It is also common that you as a carer feel drained and upset about what has happened. At times like these, you need to look after your physical and mental wellbeing as the person you care for will require more support from you. 

Similarly, the person you care for will also struggle with difficult emotions and slowly withdraw from their daily life as the condition progresses. You can encourage them to talk through their feelings with you, other family members and friends, a trained counsellor or one of the healthcare team members. You can ask their healthcare provider for a referral to a trained professional. 

Accessing care and support

Knowing where and how to access care and support is important.

It is common to have more than one healthcare professional taking care a person with breathlessness. Depending on the condition, some of the healthcare team members involved can include:

• a specialist doctor, eg, a respiratory specialist if the condition is COPD or a cancer specialist (oncologist) if it is cancer
• radiologist – a doctor who diagnoses diseases by using imaging such as x-ray, ultrasound scan or CT scan
• specialist nurse, practice nurses or district nurses
• surgeon – a doctor who performs surgery in the operating theatre
• GP
• physiotherapist
• occupational therapist
• psychologist
• palliative care team – the team consists of doctors, nurses, and other allied health professionals to help manage symptoms nearing the end of life that aims to keep patients as comfortable as possible. 

For carers: talking to the healthcare team

Sometimes, it may feel challenging to talk to the healthcare team about the person you care for because:

• the needs of the person you care for have not been heard by the healthcare team
• you and the person you care for don't understand what the healthcare team is saying
• you and the person you care for don't want to ask too many questions
• you feel left out about your patient's care (you need to understand that there are things the healthcare team can't talk to you about regarding the person you care for without their permission).

However, to make sure they get the best possible care, you need to understand what the healthcare team is saying and you need to express your concerns and the needs of the person you are caring for. 

Here are some tips to help you talk to the healthcare team:

• Prepare a list of questions you or the person you care for may have and bring to their appointment.
• Ask questions – you need to understand what is happening and how you can help.
• Ask questions which are most important first.
• You may need to ask a question more than once to make sure you understand fully.
• You can keep a note or record the conversation during the appointment.
• If the person you care for is receiving palliative care, let all the healthcare professionals involved in their care know so everyone is aware of the type of support they need.

Read more about talking to the healthcare team(external link). 

For carers: when someone dies

It can be a difficult time for you when the person you care for dies. You may find it hard to cope with and may experience grief and bereavement. 

Common emotions or feelings you may notice include:

• loneliness
• guilt
• shock or numbness
• anger
• fear
• longing
• sadness.

Some of the bodily changes you may also notice include:

• being tearful
• difficulty sleeping
• weight loss or weight gain
• loss of appetite or increased appetite
• tiredness
• lack of energy
• headaches. 

These feelings and bodily changes can come on early or later when all the practical matters such as organising a funeral have been done. 

You may find it helpful to talk things through to help you manage grief and bereavement. You can talk to your family/whānau, friends or relatives, people in a support group, or a trained professional such as a counsellor. 

There are many organisations in New Zealand that provide support, advice and counselling to help those affected by loss and grief, including:

National grief support groups Healthify, NZ
The Grief Centre(external link) The Auckland-based centre provides counselling, support groups and training in the Auckland region, and also has information and resources available on their website
Skylight NZ(external link) Offers grief counselling in some centres and also has information and resources available on their website.
Hospice NZ(external link) ph 04 381 0266
Helplines and local mental health services(external link) Mental Health Foundation, NZ

Talk to your doctor if you have difficulty coping with daily life and you are having these grief feelings longer than expected. Read more about when someone dies(external link) and about grief and loss.