Ways to manage breathlessness

If you have breathlessness, there are ways to manage it and treatments that may help. These may include:

  • breathing and relaxation techniques
  • medicines
  • oxygen
  • complementary therapies.

Your doctor may suggest using a Borg scale to show how breathless you feel at different times.

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Breathing techniques

It helps to practise breathing techniques for the first time when you are not too breathless. Then you will find them easier to do when you are breathless. Knowing there are things you can do can help you feel more in control.

Try to do these as often as possible. It might help for someone to read the instructions to you the first time. It can take some time to get used to them. Try not to force the exercises or expect instant results. Aim for a slow change from breathlessness to controlled breathing.

To start, it might help to ask your specialist nurse or GP if you can see a physiotherapist or occupational therapist. They can help you learn these techniques.

Get into a comfortable position

When you feel breathless, get into a comfortable position that supports your upper chest muscles. This allows your diaphragm and tummy to expand fully.

The following positions can help with breathlessness:

Position 1

  • Sit in a chair in an upright position, with your back supported.
  • Keep your legs uncrossed and your feet on the floor.
  • Let your shoulders drop and feel heavy, with your arms resting in your lap.
  • Keep your head up.

Breathing techniques - Position 1

Position 2

  • Sit in a chair and lean forward with your upper body.
  • Have your legs uncrossed, your feet on the floor and your shoulders relaxed.
  • Slowly lean forward so your elbows and lower arms rest on your thighs, supporting your upper body.
  • Keep your knees shoulder-width apart and let your chest relax when you lean forward.

Breathing techniques - Position 2

Position 3

  • Stand and lean forward on to a secure surface.
  • Rest your arms and elbows on the surface, so you are supporting your upper body.
  • Keep your shoulders and chest relaxed by keeping your arms shoulder-width apart.

Breathing techniques - Position 3

Position 4

  • Stand up and lean back against a wall.
  • Let your arms drop to your sides and let your shoulders feel heavy and relaxed.

Breathing techniques - Position 4

If you are in bed

Try to sit up with your back supported by pillows. This allows your chest to expand more easily.

Controlled breathing

Breathlessness can make you breathe with your upper chest and shoulder muscles, rather than your diaphragm and lower chest. This causes fast and shallow breathing, which uses more energy and makes you tired.

Controlled breathing uses your diaphragm and lower chest muscles to help you breathe more easily.

  1. Sit comfortably on an upright chair, with your neck, shoulders and back well supported.
  2. Relax your shoulders. If you find this hard, ask someone to press down gently on your shoulder to relieve some of the tension.
  3. Breathe in gently, through your nose if you can. Try to use your lower chest to breathe. When you inhale, your tummy area should expand, rather than your upper chest.
  4. Breathe out slowly and watch your tummy sink back down. Some people find it helpful to breathe out through pursed lips (like blowing out a candle).
  5. Continue doing steps 1 to 4 until your breathing is more controlled.

To check you are breathing from the lower chest, put your hands on your tummy, just below your ribcage. As you breathe in, you should feel your hands rising. As you breathe out, your hands will sink back down. Your upper chest and shoulders should not move. Try sitting beside a mirror, so you can see your lower chest moving in and out.

Using a handheld fan

Studies show that using a handheld fan to blow air onto your face, and breathing out against the fan can help calm your breathing.

Using a handheld fan is a simple but effective way of helping breathlessness. It can help you recover more quickly when you are breathless. You usually notice a difference within a couple of minutes.

Tips for using a fan:

  • Get into a comfortable position.
  • Hold the fan yourself if possible. Keep it about 15cm (6in) away from your face.
  • Let the cool air blow towards the middle of your face.
  • Carry a handheld fan with you to use whenever you need it.

You can also use a floor-standing or desktop fan. Sitting at an open window with the cool air blowing over your face can also help. You can watch a video on how to use a handheld fan the right way from the Breathlessness Intervention Service at Cambridge University Hospital.

Some hospitals, cancer centres and hospices offer breathing control and relaxation sessions.

Coping with anxiety

Being breathless can make you feel anxious or panicky. Common symptoms of anxiety are:

  • heart palpitations (heart beats that suddenly become noticeable)
  • feeling sick
  • sweating
  • a dry mouth
  • dizziness.

These feelings can cause fast, shallow breathing, which can make you more breathless. If you notice you are breathing too fast, try to recognise what triggered it.

Relaxation techniques can help you control anxiety and breathe more easily. These can take practice, so try it for 5 to 10 minutes a day to start with. Then you can do it for longer.

Some people may need to take medication to help them manage their anxiety.

Relaxed breathing techniques

Make yourself comfortable. You can do this sitting or lying down. Make sure your shoulders, back and neck are well supported.

  1. Close your eyes.
  2. Start by breathing out and then in, only as much as you need. Then breathe out slowly with a slight sigh. Do this again, as slowly as you can. As you breathe out, feel any tension in your body start to drain away. Then let your breathing go at an even, steady pace.
  3. Start to think about each part of your body, one at a time.
  4. Start with your toes. Wiggle them, then let them relax. Let them feel heavy, and free of any tension.
  5. Now think about your legs, let your thighs relax and roll outwards.
  6. Next, let your tummy muscles become soft and relaxed.
  7. Make a fist with your hands, then let go. Let your fingers become limp and still. Let this relaxed feeling spread up your arms to your shoulders.
  8. Let your shoulders relax and drop easily.
  9. Let your neck muscles relax. Your head is resting and supported. Enjoy this relaxed feeling.
  10. Let your face relax and let your jaw rest in a relaxed position.
  11. As your body feels relaxed, become aware of the all-over feeling of letting go. If your mind becomes busy again, think about which muscles have tensed and relax them.
  12. Slowly bring your attention back to the room. Have a gentle stretch and open your eyes. Get up slowly when you have finished. You may feel dizzy if you get up suddenly. Bending and stretching your arms and legs before standing up should help.

When you feel comfortable doing these exercises, try doing them listening to some relaxing music.

Medicines and other help for breathlessness

There are different medicines that can help with breathlessness. You can talk to your cancer doctor, specialist nurse or GP.

  • Painkillers

    Some types of painkillers can help relieve breathlessness. For example, morphine can be taken as a tablet, in liquid form, or by injection under the skin.

  • Sedatives

    Sedatives can help relieve anxiety. It is better to try to learn some relaxation exercises, before trying sedatives.

  • Steroids

    Steroids can help reduce inflammation in the airways of the lungs. This helps reduce breathlessness.

  • Bronchodilator drugs

    These widen the air passages and increase airflow. You usually have them through an inhaler.

  • Sterile salt water (saline)

    This can be given through a nebuliser (a machine that turns the liquid into a fine mist) to loosen sticky phlegm.

  • Diuretics

    Diuretics are medicines to help you pass more urine (pee). They can help if your breathlessness is caused by having too much fluid in or around the lungs. These drugs help you get rid of excess fluid.

Oxygen treatment

Oxygen is used to help with low oxygen levels, not to treat breathlessness. So oxygen is only suitable for people who are breathless because of low oxygen levels in the blood.

If your oxygen levels are not low, other ways to manage breathlessness may work better. Your doctor or nurse can tell you more about this. Using a fan or sitting by an open window may give the same benefit. Your doctor may give you oxygen if you have tried other ways to help with breathlessness but still feel breathless.

If you only need oxygen for short periods, your doctor may recommend oxygen that is stored in a cylinder. If you need oxygen for longer periods, they may suggest a machine that filters oxygen from the air around you (oxygen concentrator). You breathe in the oxygen through a face mask or small tubes that sit under the nostrils (nasal cannula).

If you want to go out, you can get a portable cylinder. If you use a wheelchair, you can have it fitted to this. If you want to travel with oxygen, there are a few things to consider. You can find out more from the British Lung Foundation or the NHS.

If you smoke, you need to tell the doctor prescribing the oxygen. Smoking is not allowed in a house where there is home oxygen. This is because of a serious risk of explosion and fire.

Complementary therapies

Finding a complementary therapy that helps you relax may help you manage your breathlessness. Therapies such as acupuncture, aromatherapy and meditation may be helpful. Tell your doctor if you are thinking of starting any new therapies.