Shortness of breath

If the patient has trouble breathing, the body may not get enough oxygen. Either the lungs cannot take in enough air, or the body cannot get enough oxygen through the bloodstream. A number of different problems can cause this, including chronic lung disorders, blocked airways, pneumonia, weak breathing muscles, or obesity. It can also be caused by pain, immobility, poor nutrition, stress or anxiety, allergic reactions, surgery, anemia, side effects of chemo or radiation treatment, tumor, fluid in the lungs, heart failure, and other problems.

What to look for

• Shortness of breath or trouble breathing at rest, when eating or talking, or with exercise
• Chest pain
• Faster breathing
• Faster heartbeat
• Pale or bluish-looking skin
• Blue fingernail beds
• Cold and clammy feeling skin
• Nostrils flaring when inhaling
• Wheezing

What the patient can do

• Stay calm.
• Sit up or raise the upper body to a 45° angle by raising the bed or using pillows.
• Take medicine or treatments prescribed for breathing (for example, oxygen, medicine for relief of wheezing, inhalers, or nebulizers).
• If you are not in a lot of distress, check your temperature and pulse.
• Inhale deeply through your nose and exhale through pursed lips for twice as long as it took to inhale. (This is called pursed-lip breathing.)
• If there is still no relief after 5 minutes, sit up on the side of the bed, with feet resting on a stool, arms resting on an overbed table or side table with pillows on it, and head tilted slightly forward.
• If you are coughing and spitting, note the amount of sputum and what it looks and smells like.
• Talk with your doctor about how your breathing problem affects you, especially if you avoid some of your usual activities to keep from getting out of breath.
• Try muscle relaxation to reduce anxiety. Anxiety makes breathing problems worse.
• If you keep having trouble breathing, ask your doctor about medicines you can use to help.
• If new shortness of breath starts suddenly and does not improve; your skin looks pale or blue; or if you have chest discomfort, trouble speaking, dizziness, or weakness, call 911.

What caregivers can do

• Use a watch with a second hand to check the patient’s pulse, counting the number of beats per minute. (If you count the number of beats per minute, do it without telling the patient. If the patient knows when you are counting, he may slow down or speed up the breathing rate without realizing it.)
• Check the patient’s temperature to see if he has a fever.
• If the patient is short of breath, remove or loosen tight clothing.
• Have the patient sit up in a resting position that feels comfortable to them.
• Remind them to take slow, deep breaths, and exhale slowly.
• Remove the patient from extreme temperatures, especially heat, which may make it harder to breathe.
• Note whether the patient gets out of breath when doing strenuous activity, normal activity, or when they are at rest, and whether it happens when the patient is standing, sitting, or lying down.
• Putting the patient in front of an open window or placing a fan that blows gently on the face may help some people.
• Offer any medicines or inhalers prescribed for shortness of breath.
• If home oxygen is prescribed, be sure that you know how to set it up and what flow rate to use. (Do not change the flow rate without first talking to the doctor.) Don't allow smoking or fire when oxygen is in use.

Call the doctor if the patient:

• Has trouble breathing or chest pain
• Has thick, yellow, green, and/or bloody sputum
• Develops pale or bluish skin or if the skin feels cold and clammy
• Has a fever of 100.5° F when taken by mouth
• Has flared nostrils during breathing
• Becomes confused or restless
• Has trouble speaking
• Has dizziness or weakness
• Has swelling of the face, neck, or arms
• Develops wheezing