How to Manage Shortness of Breath (Dyspnea) in the Dying

Dyspnea interventions to help hospice and palliative-care patients

Woman looking at man wearing oxygen mask
Difficulty breathing is common in end-of-life situations.. Photo © Blend Images/Getty Images

Terminally ill patients in hospice or palliative-care settings might experience difficulty breathing as they near the end of their lives. This article explains what dyspnea is, what causes it and offers some medical and non-medical interventions/treatments that can help patients breathe easier.

What is Dyspnea?

Dyspnea is a shortness of breath, or difficult or labored breathing, that can sometimes occur suddenly.

People experiencing dyspnea often describe it as shortness of breath, tightness in their chest, fighting for air, or feeling smothered; or they might simply say, "I can't breathe."

In some cases, a patient's respiration rate (how rapidly he or she breathes in and out) will increase and their chest might constrict as the patient tries to get enough air while breathing. If an individual's oxygen levels are severely compromised, discoloration might occur in his or her nail beds and/or lips.

What Causes Dyspnea?

There are many causes of dyspnea in end-of-life situations. Often, the cause is directly related to the patient's underlying disease -- especially if the diagnosis involves his or her respiratory system, such as lung cancer or chronic obstructive pulmonary disease (COPD). Dyspnea can also occur due to secondary causes, such as pneumonia or chemotherapy. Typically, several factors can contribute to a terminally ill patient experiencing dyspnea.

Because breathing is something we generally take for granted, individuals experiencing dyspnea often experience heightened anxiety. An estimated 55-70% of hospice and palliative-care patients near the end of life experience dyspnea, and some patients find their shortness of breath/breathing difficulties more distressing than physical pain.

Anxiety can cause cognitive, emotional, behavioral and physical manifestations that exacerbate dyspnea, so it's important to manage a patient's anxiety, too.

Medical Dyspnea Interventions

Because the goal of palliative care and hospice is to provide comfort to terminally ill patients, you most likely should not call 911. In these situations, if your loved one or patient experiences dyspnea, you should contact his or her treating physician immediately. The doctor or a nurse will guide you in the best treatment to provide comfort. If your patient is under hospice care, you should call the hospice agency and a hospice nurse will give you instructions over the phone before possibly sending a nurse out to evaluate the patient's symptoms.

Otherwise, medical treatments/interventions for dyspnea in hospice and palliative-care settings generally focus on relieving the patient's feeling of breathlessness, such as:

Oxygen: Administering oxygen is usually the first line of treatment.

Medications: If the cause of dyspnea is a chronic illness, such as COPD, medications in use for that illness might be reevaluated and adjusted, if necessary.

Morphine is commonly used to relieve breathlessness because it dilates blood vessels in the lungs, reduces the respiration rate, and increases the depth of breathing -- all of which can also lower the patient's anxiety level. While anti-anxiety medications can reduce a patient's feelings of anxiousness and increase his or her comfort level, they can also make dyspnea worse, however.

Non-medical Dyspnea Interventions

Non-medical interventions are very important in treating dyspnea and can be implemented during medical treatment or while you wait for medical help to arrive. Some things you can do include:

• Cool the room and make sure the patient is wearing lightweight clothing.

• Increase the humidity level in the room.

• Use a fan to blow air directly at the patient's face, provided he or she can tolerate this feeling.

• Open a nearby window to provide a breeze and/or fresh air.

• Have the patient sit upright in bed and perform deep-breathing exercises.

• Try a relaxation technique, such as playing relaxing music, applying massage or some other relaxing touch of the patient's choosing. You might also consider using guided imagery or meditation, which are two techniques that might help.

• Provide emotional support to the patient by listening closely to what he or she says and then providing reassurance.

Edited and updated by Chris Raymond, April 14, 2016.

"Dyspnea in Dying Patients" by David Hsu, M.S.C., M.D. Canadian Family Physician, Vol. 39, July 1993. Retrieved April 13, 2016.

Kinzbrunner, B.M.; Weinreb, N.J.; Policzer, J.S.; 20 Common Problems: End of Life Care, McGraw-Hill Publishing, 2002.

Ferrell, B.R. and Coyle, N.; Textbook of Palliative Nursing, Oxford University Press, 2006.

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