This is part 2 of our Breathless Series. In Part 1, we looked at some of the reasons for breathlessness in cancer patients. I also shared my husband’s experience with shortness of breath to the point he nearly died. There are both medical and non-medical approaches to alleviate the symptoms of breathlessness. In this post, we will talk about the medical approach.
The Lung Cancer Alliance
In 2017, the Lung Cancer Alliance recently held a webinar called, “Breathing Easier.” It was the first webinar in their Coping Series. This is a series designed to educate and provide practical ways to manage the most common symptoms and side effects experienced by lung cancer patients and survivors. Because Approximately half of all cancer patients complain of breathlessness at some point. (1) The information they shared is valuable to an even wider audience of cancer survivors.
Much of the information in this post comes from the webinar. I appreciate the Lung Cancer Alliance allowing me to share it (originally at Heather Erickson Author/Writer/Speaker). I encourage you to go to their website to learn more ways of coping with lung cancer.
Treat the Cancer
Dr. Lynn Reinke, Ph.D., ARNP, FAAN (University of Washington) is a nurse practitioner, recognized nationally and internationally as a dyspnea crisis management expert. She says that the first key to managing shortness of breath is to treat the lung cancer [or any cancer that has metastasized to the lungs] along with its symptoms.
When my husband, Dan, experienced severe shortness of breath, it was because his cancer was out of control. It prompted his doctors to order a new CT scan. The results told us that it was time to change treatments. The following month, there were more scans and his treatment plan changed with each one until they found one that worked. That was when he could breathe again! Until then, several other medications were used to help with his cough and breathlessness.
Medications for Breathlessness
As we learned in the first post in this series, there are many causes of breathlessness. Talk to your provider about what medications are appropriate for you.
Also, learn the correct way to use these medications to maximize effectiveness. Because many of these medications are inhaled, the technique you use is very important. When you are being prescribed an inhaled medication, a doctor or nurse will be happy to demonstrate the proper way technique. They can also give you a “spacer.” The Asthma Society of Canada has a great illustration and instructions on their site for using a spacer.
Bronchodilators such as albuterol are fast-acting and helpful to use prior to an activity that may cause shortness of breath.
Long-acting bronchodilators last 12 hours. Some use steroids and some reduce inflammation in the lungs.
Nebulizers are helpful for acute breathlessness. A nebulizer is a portable machine that delivers the medication in the form of a breathable mist.
Opioids, such as low doses of morphine (10-30 mg) are widely used to manage breathlessness. Even experts don’t fully understand why they work. The anxiety-reducing and cough-relieving effects of diamorphine make it ideal for lung cancer. Even patients with COPD can safely use oral morphine for shortness of breath, The patient starts on a low dose, and which is raised per response and side-effects. This level of morphine is well below the amount that patients are prescribed for pain.
Anti-anxiety medications such as lorazepam. Shortness of breath can trigger anxiety attacks. Anxiety, in turn, causes people to tense up and this further reduces lung capacity. It can become a vicious cycle. Anxiety medications can end this cycle.
Oxygen is only helpful if the blood levels of oxygen are low. You can still experience breathlessness without having a low blood-oxygen level. To see whether oxygen is appropriate for you, doctors will test your oxygen level with an oximeter. That’s the little clamp they place on your finger that has a red light in it. Normal blood oxygen levels are between 75 and 100 mmHg (millimeters of mercury). A level of 60 mmHg or lower indicates the need for supplemental oxygen.
People often asked why the doctors didn’t put Dan on oxygen when he was so sick. His numbers were always borderline, but not low enough to merit oxygen therapy. It was counter-intuitive to us since he was struggling to breathe. Yet, these guidelines are in place for a very good reason. Too much oxygen can be dangerous, as well. Levels of over 110 mmHg can damage the cells in your lungs.
Non-medical interventions are often the most effective way to cope with long-term treatment of breathlessness. In the next post, we will look at non-medical approaches to breathlessness, including breathing techniques and exercises. If you haven’t already signed up to receive alerts when our weekly post is up, do that now. If you know someone who is living with cancer, pass this along to them.
WHAT ARE YOUR THOUGHTS?
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In 2012 doctors diagnosed my husband, Dan, with stage IV lung cancer. Since then, our family has been learning what it means to face cancer. I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness. My goal is to help people face cancer with grace.
My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com
Also, put your memories into words with The Memory Maker’s Journal.
I also blog at Heather Erickson Author/Writer/Speaker
1 Virtual Medical Center, Breathlessness in Cancer; https://www.myvmc.com/symptoms/breathlessness-in-cancer/
2 By Trainer2a (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons