General Information about Dyspnea and Coughing
Causes of Dyspnea and Coughing
Diagnosis of Dyspnea and Coughing
Managing Dyspnea and Coughing

General Information about Dyspnea and Coughing

Dyspnea is difficult, painful breathing or shortness of breath. Patients may use different words to describe the feeling of breathlessness; terms such as "tightness in the chest" and "suffocating" are sometimes used. The distress caused by dyspnea is different for each patient, from mild discomfort in one patient to severe discomfort in another. Dyspnea is common in patients with advanced cancer, lung cancer, and in the last 6 weeks of life.

Many conditions may cause dyspnea and coughing. In cancer patients, causes may include the following:

• A tumor that spreads to the chest cavity, lung, airway, or vein that carries blood through the chest to the heart.



• Blood clots or tumor cells that break loose and block a blood vessel in the lungs.



• Pneumonia, an infection of the lung. Anticancer therapy increases a patient's risk of developing infections.



• Scarring of the lung by radiation therapy or chemotherapy.



• Weakening of the heart by chemotherapy.



• Other conditions the patient may have, such as chronic obstructive airway disease, congestive heart failure, other lung or heart diseases, weakened breathing muscles, or malnutrition.



• A history of smoking.

A diagnosis of the cause of the patient's dyspnea and coughing is helpful in planning treatment. Diagnostic tests and procedures may include the following:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.



• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.



• CT scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.



• Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made of red blood cells.



• Oxygen saturation test: A procedure to determine the amount of oxygen being carried by the red blood cells. A lower than normal amount of oxygen may be a sign of lung disease or other medical conditions. One method uses a device clipped to the finger. The device senses the amount of oxygen in the blood flowing through the finger. Another method uses a sample of blood drawn from an artery, usually in the wrist, and tested for the amount of oxygen.



• Maximum inspiratory pressure (MIP) test: The MIP is the highest pressure that can be generated while breathing in. The MIP test measures this pressure and the strength of the muscles used to breathe. The patient breathes through a device called a manometer, which measures the pressure and sends the information to a computer.

Management of Causes of Dyspnea

It may be possible to identify and treat the causes of dyspnea. Treatment may include the following:

• Treatment to shrink or destroy the tumor:
  • Radiation therapy: A cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
  
  
  
  • Hormone therapy: A cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
  
  
  
  • Chemotherapy: A cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas.
  
  
  
  • Laser therapy for tumors inside large airways: Use of a laser beam (a narrow beam of intense light) as a knife to remove the tumor.
  
  
  
  • Cauterization of tumors inside large airways: Use of a hot instrument, an electric current, or a caustic substance to destroy the tumor.
  
  
  



• Stent placement

  If a large airway is blocked by a tumor that is pressing on it from the outside, surgery may be done to place a stent (a thin tube) within the airway to keep it open.




• Medications
  • Steroid drugs to reduce the inflammation and swelling of lymph vessels in the lungs.
  
  
  
  • Bronchodilators, medicines that are inhaled to open up the bronchioles (small airways) in the lungs.
  
  
  
  • Diuretics and other drugs for heart failure.
  
  
  
  • Antibiotics for chest infections. These may be combined with chest physical therapy.
  
  
  



• Procedures to remove fluid that has built up around the lungs (See Managing Malignant Pleural Effusions) or in the abdominal cavity.



• Blood transfusions for anemia

Management of Symptoms of Dyspnea

Management of the symptoms of dyspnea may include the following:

• Oxygen therapy

  Patients who cannot breathe enough oxygen from the air may be given supplemental oxygen to inhale from tanks or cylinders. Devices that concentrate oxygen already in the air may also be prescribed.




• Medicines

  Pain medicines may reduce physical and mental distress and exhaustion, and improve the patient's quality of life. Other drugs may be used to treat dyspnea that is related to panic disorder or severe anxiety.




• Support and counseling

  Supportive measures may be effective for some patients. These measures include the following:

  • New breathing techniques.
  • Cold air directed across the cheek.
  • Meditation.
  • Relaxation training.
  • Biofeedback.
  • Psychotherapy.

Management of Chronic Cough

In some patients, chronic (long-term) coughing causes pain, interferes with sleep, and worsens dyspnea and fatigue. Treatments include the following:

• Cough-suppressing medicine.
• Medicines that break down mucus.
• An inhaled drug for chronic coughing related to lung cancer.

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