Breathlessness in palliative care

Key points about breathlessness in palliative care

  • Breathlessness is the uncomfortable sensation of feeling short of breath and having difficulty breathing.
  • It's a common and distressing symptom for people living with a terminal illness and can be caused by many things.
  • You may have many health professionals involved in your care as breathlessness requires treatment from a multidisciplinary team. 
  • Things you can do to help manage breathlessness, include taking medicine, using breathing techniques, changing your position and doing relaxation exercises.
  • Living with breathlessness can be frightening, so make sure you get enough support from your family/whānau and friends.
Breathless woman sitting with hand on chest
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There are many causes that can contribute to the feeling of being short of breath. It may come and go quickly (acute) or may come on slowly and last for a longer time (chronic).

It can be caused by the terminal illness you are living with, eg, lung cancer, or other medical conditions that happen at the same time. Breathlessness can also be caused by psychological factors such as anxiety and fear. Sometimes, it's not possible to find out an exact cause. 

Common causes of breathlessness in patients living with a terminal illness include:

  • cancer and its complications, such as pleural effusion, pulmonary embolism or airway obstruction
  • conditions affecting your lungs, such as COPD 
  • heart conditions such as heart failure
  • muscle weakness
  • fatigue
  • infection
  • metabolic acidosis (your body makes too much acid)
  • low blood count (anaemia)
  • smoking
  • pain
  • anxiety and fear.

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

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

See your doctor straight away if you have any of these symptoms starting suddenly. 

Your doctor may ask you some questions to find out the possible causes of your breathlessness. You may need to complete a symptom diary to monitor the timing of your breathlessness, what triggers it and how it is affecting your daily life. 

Your doctor may also do a physical examination to check for signs of illness or disease and carry out tests to rule out physical causes, such as blood and urine tests. 

Treatment aims to relieve your symptom of being short of breath and to make you feel better. You may have many health professionals such as doctors, nurses, a physiotherapist, an occupational therapist, a palliative care specialist or a cancer specialist involved in your care, as it requires treatment from a multidisciplinary team. 

If you have a medical condition or any obvious causes of breathlessness are found, treatment will focus on the condition or cause. 

There are 2 components of the treatment of breathlessness:

  • non-medicines treatment
  • medicines.

Non-medicine treatment

The non-medicine treatment of breathlessness includes:

  • physiotherapy
  • counseling
  • relaxation techniques
  • breath control techniques
  • good positioning
  • blood transfusion if you have anaemia 
  • complementary therapies such as aromatherapy, music and art therapy.

You may be referred to a physiotherapist, an occupational therapist, a psychologist or a complementary therapist as part of your treatment. 


There are also some medicines that can help relieve your breathlessness.

Common medicines that may be prescribed include:

Nearing the end of life, some of these medicines may be given to you via subcutaneous injection (under your skin) or a syringe driver. Read more about syringe drivers

You may receive both non-medicine and medicine treatment together, depending on your condition. 

There are several things you can do to help manage breathlessness. 

  • Try sitting in an area that has good ventilation, eg, by an open window or using a small fan.
  • Use a cool damp cloth or fine mist spray on your face.
  • Plan activities in advance, break down tasks and do them one by one, taking frequent breaks in between.
  • Practice mindfulness and relaxation exercies.
  • Practice breath control techniques – a physiotherapist or occupational therapist can teach you how to do these.
  • Wear loose-fitting clothes.
  • Sit down to dress or do other tasks.
  • Change your body position.
  • Listen to music or turn on the TV to distract yourself – distraction helps.
  • Use a walker if needed.
  • If you smoke, get help to stop.
  • If you are on medication for your breathing, make sure you take it as prescribed.

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 on 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 you 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 to help you feel more relaxed and calm. Read more about mindfulness.

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

If you need extra help in daily activities such as washing, dressing or cooking, your doctor may be able to arrange this for you. 

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

Emotions and cancer(external link) Cancer Society of NZ
How we can help(external link) Cancer Society of NZ
NZ cancer services - find a hospital/service near you(external link) Healthpoint, NZ
More cancer support groups

Clinical update

The following information is taken from The palliative care handbook(external link) Hospice NZ, 2019.

Breathlessness is one of the most common and distressing symptoms for both patients and relatives as the end of life approaches.

  • It has a reported incidence of 29–74% of people near the end of life.
  • The distress caused by breathlessness should not be underestimated.
  • A careful evaluation of the nature of the breathlessness is important.
  • Listening to the descriptors (the language that the patient uses to describe the sensation) of the quality and quantity of breathlessness is important in choosing management.
  • Breathlessness will only rarely be expressed in purely physical terms.
  • The assessment of breathlessness should use a multidimensional approach, as with the assessment of pain.
  • Identifying the cause(s) is an essential step in effective management.


  • Careful assessment of each situation to identify probable causes is an essential starting point.
  • Pay particular attention to the descriptions the patient gives of the sensation and experience of breathlessness and ask specifically, ‘How would you describe your breathlessness today?’
  • Severity and meaning for each individual is important as dyspnoea may have a variable effect on quality of life at the end of life, varying with the cause(s) and the individual’s perception of the meaning of the symptom.
  • In a broad sense, dyspnoea has at least 5 main components, each of which must be attended to:
    – sensation (what it feels like)
    – perception (how it is viewed in the context of the illness)
    – distress (does it cause suffering or grief?)
    – response (how individuals react)
    – reporting (the language used to relay these elements).

See our page Palliative care for healthcare providers

Clinical resources and guidelines

The palliative care handbook(external link) Hospice NZ, 2019
Serious illness conversation guide Aotearoa(external link) Health Quality & Safety Commission, NZ, 2019
Breathlessness – management in the palliative patient(external link) Starship Clinical Guidelines, NZ, 2015
Managing breathlessness in palliative care(external link) BPAC, NZ, 2012
Breathlessness(external link) Marie Curie, UK
Dyspnoea in palliative care(external link) Patient Info, UK


breathlessness brochure from mercy hospice


Mercy Hospice, NZ, 2020

what to do when breathless

What to do when very breathless

Auckland Hospital Palliative Care Service

Managing your breathlessness

St Christopher's, UK, 2021

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Credits: Healthify editorial team. Healthify is brought to you by Health Navigator Charitable Trust.

Reviewed by: Jarna Standen, Registered Nurse, Mercy Hospice, Auckland

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