Dyspnea and Coughing During Advanced Cancer
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.
Causes of Dyspnea and Coughing
Many conditions may cause dyspnea and coughing. In cancer patients, causes may include the following:
- Direct effects of the tumor:
- Indirect effects of the tumor:
- Treatment-related effects:
- Conditions the patient may have unrelated to the cancer:
- Conditions with no known physical cause, such as anxiety.
Diagnosis of Dyspnea and Coughing
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.
- Functional assessment: An exam to check for how the dyspnea affects the patient's ability to perform activities of daily living.
- 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:
- 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.
Managing Dyspnea and Coughing
Management of Causes of Dyspnea
It may be possible to identify and treat the causes of dyspnea. Treatment may include the following:
Management of Symptoms of Dyspnea
Management of the symptoms of dyspnea may include the following:
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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.
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Medicines
Opioids 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.
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General support
Supportive measures may be effective for some patients. These measures include the following:
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:
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