General Information about Dyspnea and Coughing
Causes of Dyspnea and Coughing
Diagnosis of Dyspnea and Coughing
Managing Dyspnea and Coughing

General Information about Dyspnea and Coughing

Dyspnea is difficult, painful breathing or shortness of breath. Patients may use different words to describe the feeling of breathlessness; terms such as "tightness in the chest" and "suffocating" are sometimes used. The distress caused by dyspnea is different for each patient, from mild discomfort in one patient to severe discomfort in another. Dyspnea is common in patients with advanced cancer, lung cancer, and in the last 6 weeks of life.

Many conditions may cause dyspnea and coughing. In cancer patients, causes may include the following:

• A tumor that spreads to the chest cavity, lung, airway, or vein that carries blood through the chest to the heart.



• Blood clots or tumor cells that break loose and block a blood vessel in the lungs.



• Pneumonia, an infection of the lung. Anticancer therapy increases a patient's risk of developing infections.



• Scarring of the lung by radiation therapy or chemotherapy.



• Weakening of the heart by chemotherapy.



• Other conditions the patient may have, such as chronic obstructive airway disease, congestive heart failure, other lung or heart diseases, weakened breathing muscles, or malnutrition.



• A history of smoking.

A diagnosis of the cause of the patient's dyspnea and coughing is helpful in planning treatment. Diagnostic tests and procedures may include the following:

• Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.



• Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.



• CT scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.



• Complete blood count: A procedure in which a sample of blood is drawn and checked for the following:
  • The number of red blood cells, white blood cells, and platelets.
  • The amount of hemoglobin (the protein that carries oxygen) in the red blood cells.
  • The portion of the blood sample made of red blood cells.



• Oxygen saturation test: A procedure to determine the amount of oxygen being carried by the red blood cells. A lower than normal amount of oxygen may be a sign of lung disease or other medical conditions. One method uses a device clipped to the finger. The device senses the amount of oxygen in the blood flowing through the finger. Another method uses a sample of blood drawn from an artery, usually in the wrist, and tested for the amount of oxygen.



• Maximum inspiratory pressure (MIP) test: The MIP is the highest pressure that can be generated while breathing in. The MIP test measures this pressure and the strength of the muscles used to breathe. The patient breathes through a device called a manometer, which measures the pressure and sends the information to a computer.

Management of Causes of Dyspnea

It may be possible to identify and treat the causes of dyspnea. Treatment may include the following:

• Treatment to shrink or destroy the tumor:
  • Radiation therapy: A cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.
  
  
  
  • Hormone therapy: A cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
  
  
  
  • Chemotherapy: A cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas.
  
  
  
  • Laser therapy for tumors inside large airways: Use of a laser beam (a narrow beam of intense light) as a knife to remove the tumor.
  
  
  
  • Cauterization of tumors inside large airways: Use of a hot instrument, an electric current, or a caustic substance to destroy the tumor.
  
  
  



• Stent placement

  If a large airway is blocked by a tumor that is pressing on it from the outside, surgery may be done to place a stent (a thin tube) within the airway to keep it open.




• Medications
  • Steroid drugs to reduce the inflammation and swelling of lymph vessels in the lungs.
  
  
  
  • Bronchodilators, medicines that are inhaled to open up the bronchioles (small airways) in the lungs.
  
  
  
  • Diuretics and other drugs for heart failure.
  
  
  
  • Antibiotics for chest infections. These may be combined with chest physical therapy.
  
  
  



• Procedures to remove fluid that has built up around the lungs (See Managing Malignant Pleural Effusions ¹) or in the abdominal cavity.



• Blood transfusions for anemia

Management of Symptoms of Dyspnea

Management of the symptoms of dyspnea may include the following:

• Oxygen therapy

  Patients who cannot breathe enough oxygen from the air may be given supplemental oxygen to inhale from tanks or cylinders. Devices that concentrate oxygen already in the air may also be prescribed.




• Medicines

  Pain medicines may reduce physical and mental distress and exhaustion, and improve the patient's quality of life. Other drugs may be used to treat dyspnea that is related to panic disorder or severe anxiety.




• Support and counseling

  Supportive measures may be effective for some patients. These measures include the following:

  • New breathing techniques.
  • Cold air directed across the cheek.
  • Meditation.
  • Relaxation training.
  • Biofeedback.
  • Psychotherapy.

Management of Chronic Cough

In some patients, chronic (long-term) coughing causes pain, interferes with sleep, and worsens dyspnea and fatigue. Treatments include the following:

• Cough-suppressing medicine.
• Medicines that break down mucus.
• An inhaled drug for chronic coughing related to lung cancer.

Glossary Terms

The area of the body that contains the pancreas, stomach, intestines, liver, gallbladder, and other organs.

A drug used to treat infections caused by bacteria and other microorganisms.

Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.

A blood vessel that carries blood from the heart to tissues and organs in the body.

A method of learning to voluntarily control certain body functions such as heartbeat, blood pressure, and muscle tension with the help of a special machine. This method can help control pain.

A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.

A tube through which the blood circulates in the body. Blood vessels include a network of arteries, arterioles, capillaries, venules, and veins.

A tiny branch of air tubes in the lungs.

A term for diseases in which abnormal cells divide without control. Cancer cells can invade nearby tissues and can spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is cancer that starts in blood-forming tissue such as the bone marrow, and causes large numbers of abnormal blood cells to be produced and enter the blood. Lymphoma and multiple myeloma are cancers that begin in the cells of the immune system. Central nervous system cancers are cancers that begin in the tissues of the brain and spinal cord.

A flexible tube used to deliver fluids into or withdraw fluids from the body.

To destroy tissue using a hot or cold instrument, an electrical current, or a chemical that burns or dissolves the tissue. This process may be used to kill certain types of small tumors or to seal off blood vessels to stop bleeding.

The individual unit that makes up the tissues of the body. All living things are made up of one or more cells.

Treatment with drugs that kill cancer cells.

An x-ray of the structures inside the chest. An x-ray is a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease.

A disease or condition that persists or progresses over a long period of time.

CBC. A test to check the number of red blood cells, white blood cells, and platelets in a sample of blood. Also called blood cell count and CBC.

Weakness of the heart muscle that leads to a buildup of fluid in body tissues.

A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.

Computed tomography scan. A series of detailed pictures of areas inside the body taken from different angles; the pictures are created by a computer linked to an x-ray machine. Also called computed tomography scan, computerized tomography, computerized axial tomography scan, and CAT scan.

The process of identifying a disease, such as cancer, from its signs and symptoms.

A method used to identify a disease.

In medicine, a disturbance of normal functioning of the mind or body. Disorders may be caused by genetic factors, disease, or trauma.

A drug that increases the production of urine.

Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.

Difficult, painful breathing or shortness of breath.

A type of radiation therapy that uses a machine to aim high-energy rays at the cancer from outside of the body. Also called external-beam radiation therapy.

A condition marked by extreme tiredness and inability to function due lack of energy. Fatigue may be acute or chronic.

An organ that makes one or more substances, such as hormones, digestive juices, sweat, tears, saliva, or milk. Endocrine glands release the substances directly into the bloodstream. Exocrine glands release the substances into a duct or opening to the inside or outside of the body.

The substance inside red blood cells that binds to oxygen and carries it from the lungs to the tissues.

One of many chemicals made by glands in the body. Hormones circulate in the bloodstream and control the actions of certain cells or organs. Some hormones can also be made in the laboratory.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called hormonal therapy, hormone treatment, or endocrine therapy.

Invasion and multiplication of germs in the body. Infections can occur in any part of the body and can spread throughout the body. The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on where the infection occurs. When the body’s natural defense system is strong, it can often fight the germs and prevent infection. Some cancer treatments can weaken the natural defense system.

Redness, swelling, pain, and/or a feeling of heat in an area of the body. This is a protective reaction to injury, disease, or irritation of the tissues.

In medicine, refers to the act of taking a substance into the body by breathing.

Use of a syringe and needle to push fluids or drugs into the body; often called a "shot."

A type of radiation therapy in which radioactive material sealed in needles, seeds, wires, or catheters is placed directly into or near a tumor. Also called brachytherapy, radiation brachytherapy, and implant radiation therapy.

A device that concentrates light into an intense, narrow beam used to cut or destroy tissue. It is used in microsurgery, photodynamic therapy, and for a variety of diagnostic purposes.

The use of an intensely powerful beam of light to kill cancer cells.

One of a pair of organs in the chest that supplies the body with oxygen, and removes carbon dioxide from the body.

A thin tube that carries lymph (lymphatic fluid) and white blood cells through the lymphatic system. Also called lymphatic vessel.

A disorder caused by a lack of proper nutrition or an inability to absorb nutrients from food.

A thick, slippery fluid made by the membranes that line certain organs of the body, including the nose, mouth, throat, and vagina.

Blockage of a passageway.

A part of the body that performs a specific function. For example, the heart is an organ.

An exam of the body to check for general signs of disease.

The use of exercises and physical activities to help condition muscles and restore strength and movement. For example, physical therapy can be used to restore arm and shoulder movement and build back strength after breast cancer surgery.

A type of blood cell that helps prevent bleeding by causing blood clots to form. Also called a thrombocyte.

A severe inflammation of the lungs in which the alveoli (tiny air sacs) are filled with fluid. This may cause a decrease in the amount of oxygen that blood can absorb from air breathed into the lung. Pneumonia is usually caused by infection but may also be caused by radiation therapy, allergy, or irritation of lung tissue by inhaled substances. It may involve part or all of the lungs.

A doctor's order for medicine or another intervention.

A molecule made up of amino acids that are needed for the body to function properly. Proteins are the basis of body structures such as skin and hair and of substances such as enzymes, cytokines, and antibodies.

The overall enjoyment of life. Many clinical trials assess the effects of cancer and its treatment on the quality of life. These studies measure aspects of an individual’s sense of well-being and ability to carry out various activities.

Energy released in the form of particles or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, and medical x-rays.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called radiotherapy and irradiation.

Giving off radiation.

A small, radioactive pellet that is placed in or near a tumor. Cancer cells are killed by the energy given off as the radioactive material breaks down and becomes more stable.

A molecule inside or on the surface of a cell that binds to a specific substance and causes a specific physiologic effect in the cell.

RBC. A cell that carries oxygen to all parts of the body. Also called RBC and erythrocyte.

The bones, muscles, tendons, and other tissues that reach from the base of the skull to the tailbone. The spinal column encloses the spinal cord and the fluid surrounding the spinal cord. Also called spine, backbone, and vertebral column.

A device placed in a body structure (such as a blood vessel or the gastrointestinal tract) to keep the structure open.

A type of drug used to relieve swelling and inflammation. Some steroid drugs may also have antitumor effects.

A procedure to remove or repair a part of the body or to find out whether disease is present. An operation.

Treatment with anticancer drugs that travel through the blood to cells all over the body.

Treatment.

A group or layer of cells that work together to perform a specific function.

An abnormal mass of tissue that results when cells divide more than they should or do not die when they should. Tumors may be benign (not cancerous), or malignant (cancerous). Also called neoplasm.

Refers to a blood cell that does not contain hemoglobin. White blood cells include lymphocytes, neutrophils, eosinophils, macrophages, and mast cells. These cells are made by bone marrow and help the body fight infections and other diseases. Also called WBC.