Managing Shortness of Breath

Dyspnea is the medical term for difficult, labored breathing or shortness of breath. No one can spell it or say it, but it's helpful to know. Shortness of breath is a common symptom if a hospice patient has a lung or respiratory disease. 

The inability to breathe effectively is terrifying and exhausting for most patients. The smallest things in life require inordinate amounts of energy: talking, chewing, moving, getting on the toilet, getting off the toilet. Their life shrinks down to a 15-foot diameter in which they can only walk from the bed to the chair to the toilet… with their oxygen tubing dangling behind. 

It is not uncommon for these patients to have accompanying agitation or frustration.

When your loved one is short of breath, call the hospice team. These simple tactics may be useful right away.

• Open a window to let in cool air.

• Position their bed facing a window so they don’t feel claustrophobic. Always keep the doors open.

• Turn on a fan and let it blow gently on their face.

• Help them to sit high up in the bed. Sometimes it helps to lean onto a table.

• Give the patient some space and grace to be frustrated and/or agitated.

Call hospice for medical interventions such as:

• Oxygen

  • You need a doctor’s order to obtain or to increase liter flow because certain diseases cannot tolerate an increase in oxygen. Here is an AARP video that provides excellent information on oxygen. 

  • Some patients do not want anything up their nose, period. In these cases, I consider where they are in the disease process and decline and may choose a different intervention—oftentimes, morphine can provide them with greater relief without the annoyance of the nasal cannula or the sound of the oxygen concentrator humming nearby. 

• Medications 

  • Morphine is the gold-standard opioid used for shortness of breath, but all opioids help to alleviate patients’ air hunger. The hospice team may increase the patient’s current opioid, or initiate morphine. Every hospice patient receives highly concentrated liquid morphine (Roxanol) when they are admitted to hospice to anticipate sudden pain or shortness of breath. Your nurse will instruct you on how to administer this medication.  Here is my blog post on initiating morphine.

  • Ativan is another medication included in the emergency comfort kit which alleviates anxiety. Anxiety exacerbates shortness of breath, and shortness of breath aggravates anxiety. 

• The hospice team may prescribe other medications such as inhalers, nebulizers, or steroids, depending on the disease process. 

Breathing is something we all take for granted until we cannot breathe effectively. In my experience, shortness of breath leads to fatigue, decreased mobility, anxiety (fear of suffocating), isolation (it becomes too exhausting to socialize), weight loss (chewing and breathing is too much work), and depression (from one’s loss of independence). Managing your loved one’s shortness of breath is critical to improving their quality of life.

Saddle up next to your loved one to provide the necessary emotional support, learn about their medications and oxygen tanks so they are not solely responsible for their ability to breathe, and take a breath yourself. Always call on the hospice team for support and recommendations.