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Breathlessness & coughing in palliative care

Hēmanawa me maremare ki te manaakitanga whakamaene

Being short of breath or breathless, can be common for people receiving palliative care. It can also be quite upsetting. The breathlessness might come and go, or it might last all day.

Several things can cause breathlessness, including:

lung issues, such as COPD, asthma or inflammation in your lungs caused by radiation treatment
heart problems, such as heart failure or fluid around your heart
problems in your blood, such as anaemia or an infection
problems with the nerves and muscles you use to breathe
cancer – the cancer itself, a tumour blocking your airways, fluid caused by the cancer building up around your lungs or similar issues
anxiety.

If breathlessness is worrying you, see a doctor or nurse practitioner to find out what is causing it and to get help to ease your distress.

There may be treatments that can help. These could include chemotherapy, radiotherapy or a change to your medications.

If your breathlessness cannot be medically treated, your doctor will need to check how anxious it is making you. They will also check how it is affecting your day-to-day life and how uncomfortable it is for you. They may have some other options for managing your breathing that can help.

Managing breathlessness

Several things can help to manage breathlessness. They include medicines, but they also include other strategies.

Strategies for breathlessness

relaxation techniques
breathing control techniques, such as dropping your shoulders when you breathe out
distraction techniques, such as listening to music
changing the way you lie, sit or stand
managing how much energy you use by using equipment such as a walking frame, or changing the way you do tasks, such as dressing in stages while sitting
directing fresh air onto your face by sitting near an open door or window or blowing a fan across your face
taking opportunities to relax and using mindfulness to concentrate on making your breathing calm and relaxing
getting help from a physiotherapist, occupational therapist or counsellor
having frequent rest periods and pacing the tasks you do
asking others to help with tasks around the home and not doing them all yourself
doing simple exercises, such as straightening one leg at a time when sitting in a chair or practising sitting up and down. This helps keep your leg muscles strong, which can help your breathing feel easier when you walk. Ask your doctor if you need more exercise advice or a referral to a physiotherapist or occupational therapist.

Medicines for breathlessness

There are several medicines that your doctor might try to treat your shortness of breath.

Medicines given through a nebuliser, such as salbutamol or saline.
Morphine – at low doses, this can help breathlessness.
Steroids such as prednisone.
Anti-anxiety medicines such as midazolam. These medicines are sedating and are only useful for severe anxiety or panic. Midazolam is short-acting and addictive. Also, the benefit wears off if it is used regularly. It is usually reserved for those who only have a short time to live.
Oxygen (only in those who have low oxygen levels). This needs to be approved and prescribed by a hospital specialist.

Your doctor may write you a breathlessness management plan. This is so you and your whānau (family) know what to do and who to call if your usual strategies and medicines are not helping.

Coughing

Coughing can be a troublesome symptom. It can interfere with your sleeping, eating, drinking and communicating.

Several things might cause coughing. These include lung cancer, a chest infection or a lung condition such as chronic obstructive pulmonary disease (COPD). It often happens with other symptoms, such as breathlessness, wheezing or a tight chest. Your doctor will try to identify what is making you cough and treat it if possible.

Things that may help reduce your coughing include:

changing your position, particularly during the night
steam inhalation or using a nebuliser with a saline solution
chest physiotherapy
sipping water
a soothing cough syrup (linctus). You can buy one from a pharmacy – ask your general practice team which one will be best for you.

Your doctor might also prescribe other medicines to help suppress your cough. These may include antibiotics, opioids such as morphine or steroids.

Written by HealthInfo clinical advisers. Last reviewed October 2024.

Sources

The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public

Canterbury Community HealthPathways – Cough in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Dyspnoea in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Pruritus (itch) in palliative care, retrieved December 2016.

Canterbury Community HealthPathways – Weakness and fatigue in palliative care, retrieved December 2016.

Canterbury DHB – Palliative care guidelines (http://cdhb.palliativecare.org.nz/4207.htm), retrieved August 2016.

Nurse Maude – Symptom management, retrieved December 2016.

Palliative Care Australia – Facts about morphine and other opioid medicines in palliative care, retrieved February 2017.

Palliative Care Australia – Learn more about pain and pain management, retrieved February 2017.

South Island Alliance – Health of older people useful resources (https://www.sialliance.health.nz/programmes/health-of-older-people/useful-resources/), retrieved September 2022.

UpToDate – Managing pain when you have cancer, retrieved February 2017.

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Review key: HIPAL-17434