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:

• Direct effects of the tumor:
  • A tumor that spreads to airways, the chest cavity, lung, vein that carries blood through the chest to the heart, or lymph vessels near the lungs.
  • Pericardial effusion (too much fluid inside the sac that covers the heart).
• Indirect effects of the tumor:
  • Pneumonia, an infection of the lung. Anticancer therapy increases a patient's risk of developing infections.
  • Blood clots or tumor cells that break loose and block a blood vessel in the lungs.
  • Paralysis of part of the diaphragm.
• Treatment-related effects:
  • Scarring of the lung by radiation therapy or chemotherapy.
  • Weakening of the heart muscle by chemotherapy.
• Conditions the patient may have unrelated to the cancer:
  • Chronic obstructive airway disease.
  • Congestive heart failure.
  • Anemia.
  • A condition in which the blood is too acidic.
  • Weakened muscles in the airways that cause spasms.
• Conditions with no known physical cause, such as anxiety.

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.
• Functional assessment: An exam to check for how the dyspnea affects the patient's ability to perform activities of daily living.
• 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.
  • Opioids, to treat moderate to severe pain.
  • Anticoagulants, for blood clots that are blocking blood vessels in the lungs.

• Procedures to remove fluid that has built up around the lungs (see Managing Malignant Pleural Effusions ¹), around the heart (see Managing Malignant Pericardial Effusions) ², 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

  Opioids 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.

• General support

  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.

The tasks of everyday life. These activities include eating, dressing, getting into or out of a bed or chair, taking a bath or shower, and using the toilet. Instrumental activities of daily living are activities related to independent living and include preparing meals, managing money, shopping, doing housework, and using a telephone. Also called ADL.

Cancer that has spread to other places in the body and usually cannot be cured or controlled with treatment.

A condition in which the number of red blood cells is below normal.

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

A drug that helps prevent blood clots from forming. Also called blood thinner.

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.

In healthcare, a process used to learn about a patient’s condition. This may include a complete medical history, medical tests, a physical exam, a test of learning skills, tests to find out if the patient is able to carry out the tasks of daily living, a mental health evaluation, and a review of social support and community resources available to the patient.

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 mass of blood that forms when blood platelets, proteins, and cells stick together. When a blood clot is attached to the wall of a blood vessel, it is called a thrombus. When it moves through the bloodstream and blocks the flow of blood in another part of the body, it is called an embolus.

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 type of drug that causes small airways in the lungs to open up. Bronchodilators are inhaled and are used to treat breathing disorders, such as asthma or emphysema.

A term for diseases in which abnormal cells divide without control and can invade nearby tissues. Cancer cells can also spread to other parts of the body through the blood and lymph systems. There are several main types of cancer. Carcinoma is a cancer that begins in the skin or in tissues that line or cover internal organs. Sarcoma is a cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue. Leukemia is a 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. Also called malignancy.

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.

A hollow area or hole. It may describe a body cavity (such as the space within the abdomen) or a hole in a tooth caused by decay.

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.

A type of lung disease marked by permanent damage to tissues in the lungs, making it hard to breathe. Chronic obstructive pulmonary disease includes chronic bronchitis, in which the bronchi (large air passages) are inflamed and scarred, and emphysema, in which the alveoli (tiny air sacs) are damaged. It develops over many years and is usually caused by cigarette smoking. Also called COPD.

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.

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 CAT scan, computed tomography scan, computerized axial tomography scan, and computerized tomography.

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

A specific test or series of steps done to help diagnose a disease or condition. Mammograms and colonscopies are examples of diagnostic procedures.

The thin muscle below the lungs and heart that separates the chest from the abdomen.

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

Extreme mental or physical pain or suffering.

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.

A substance that flows smoothly and takes the shape of its container. Liquids and gases are fluids.

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 in the lungs and carries it 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 endocrine therapy, hormonal therapy, and hormone treatment.

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, implant radiation therapy, and radiation brachytherapy.

A device that forms light into intense, narrow beams that may be used to cut or destroy tissue, such as cancer tissue. It may also be used to reduce lymphedema (swelling caused by a buildup of lymph fluid in tissue) after breast cancer surgery. Lasers are used in microsurgery, photodynamic therapy, and many other procedures to diagnose and treat disease.

Treatment that uses intense, narrow beams of light to cut and destroy tissue, such as cancer tissue. Laser therapy may also be used to reduce lymphedema (swelling caused by a buildup of lymph fluid in tissue) after breast cancer surgery.

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

Cancer that forms in tissues of the lung, usually in the cells lining air passages. The two main types are small cell lung cancer and non-small cell lung cancer. These types are diagnosed based on how the cells look under a microscope.

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

A test that measures the strength of the muscles used in breathing. A person inhales and exhales through a device called a manometer, and the pressures are recorded by a computer. Also called MIP test.

Refers to the practices and procedures used for the prevention, treatment, or relief of symptoms of a diseases or abnormal conditions. This term may also refer to a legal drug used for the same purpose.

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

A substance used to treat moderate to severe pain. Opioids are like opiates, such as morphine and codeine, but are not made from opium. Opioids bind to opioid receptors in the central nervous system. Opioids used to be called narcotics. An opioid is a type of alkaloid.

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

A colorless, odorless gas. It is needed for animal and plant life. Oxygen that is breathed in enters the blood from the lungs and travels to the tissues.

A test that measures the amount of oxygen being carried by red blood cells. One method uses a device that shines light through a finger. The device measures the amount of oxygen in the blood based on the way red blood cells carrying oxygen absorb and reflect light. In another method blood is taken from an artery and the amount of oxygen is measured directly. An oxygen level that is lower than normal may be a sign of lung disease or other medical conditions.

Sudden extreme anxiety or fear that may cause irrational thoughts or actions. Panic may include rapid heart rate, flushing (a hot, red face), sweating, and trouble breathing.

Loss of ability to move all or part of the body.

An abnormal collection of fluid inside the sac that covers the heart.

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 tiny piece of a cell found in the blood that breaks off from a large cell found in the bone marrow. Platelets help wounds heal and prevent bleeding by forming blood clots. Also called 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.

Treatment of mental, emotional, personality, and behavioral disorders using methods such as discussion, listening, and counseling. Also called talk therapy.

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 particle or electromagnetic waves. Common sources of radiation include radon gas, cosmic rays from outer space, medical x-rays, and energy given off by a radioisotope (unstable form of a chemical element that releases radiation as it breaks down and becomes more stable).

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 irradiation and radiotherapy.

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.

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

A method used to reduce tension and anxiety, and control pain.

A sudden contraction of a muscle or group of muscles, such as a cramp.

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 backbone, spine, 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.

An indication that a person has a condition or disease. Some examples of symptoms are headache, fever, fatigue, nausea, vomiting, and pain.

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 cancer), or malignant (cancer). Also called neoplasm.

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

A type of immune cell. Most white blood cells are made in the bone marrow and are found in the blood and lymph tissue. White blood cells help the body fight infections and other diseases. Granulocytes, monocytes, and lymphocytes are white blood cells. Also called leukocyte and WBC.

A type of high-energy radiation. In low doses, x-rays are used to diagnose diseases by making pictures of the inside of the body. In high doses, x-rays are used to treat cancer.