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Cardiopulmonary Syndromes (PDQ®): Supportive care - Patient Information [NCI] - Dyspnea and Coughing During Advanced Cancer

Many conditions can cause dyspnea.

Dyspnea is the feeling of difficult or uncomfortable breathing or of not getting enough air. It also may be called shortness of breath, breathlessness, or air hunger. In cancer patients, causes of dyspnea include the following:

  • Effects related to the tumor:
    • The tumor blocks the airways in the chest and lung or the vein that carries blood through the chest to the heart.
    • The tumor causes extra fluid to build up in the space between the thin layer of tissue covering the lung and the thin layer of tissue covering the chest wall (pleural effusion), between the sac that covers the heart and the heart (pericardial effusion), or in the abdominal cavity (ascites).
    • Carcinomatous lymphangitis (inflammation of the lymph vessels).
    • Chest infections. Some cancer treatments may increase the risk of an infection, such as pneumonia.
    • Blood clots or tumor cells that break loose and block a blood vessel in the lungs.
    • Paralysis of part of the diaphragm (a muscle used for breathing).
    • Breathing muscles get weaker.
  • Effects related to treatment:
    • Damage to the lung caused by radiation therapy or chemotherapy.
    • Weakened heart muscle caused by chemotherapy.
  • Conditions that are not related to cancer:
    • Chronic obstructive pulmonary disease (COPD), such as chronic bronchitis or emphysema.
    • Bronchospasm. The muscles in the airways contract and cause spasms.
    • A weak diaphragm.
    • Congestive heart failure.
    • Anemia.
  • Conditions with no known physical cause, such as anxiety.

A diagnosis of the cause of dyspnea or coughing helps to plan treatment.

Diagnostic tests and procedures include the following:

  • Physical exam and history for dyspnea: An exam of the body to check general signs of health, including checking for signs of dyspnea, such as breathing fast or using the neck or chest muscles to breathe. A history of your health habits and past illnesses and treatments will also be taken. Your doctor will also ask about when the dyspnea occurs, what it feels like, other symptoms that happen at the same time as the dyspnea, and anything that makes it better or worse.
  • Functional assessment: An exam to check for how the dyspnea affects your ability to perform activities of daily living such as eating, bathing, or climbing stairs.
  • 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 (CAT 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 taken 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 check for 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 health problems. One method uses a device clipped to the finger. The device senses the amount of oxygen in the blood flowing through the small blood vessels in the finger. Another method uses a sample of blood taken from an artery, usually in the wrist, that is tested for the amount of oxygen.
  • Maximum inspiratory pressure (MIP) test: The MIP is the highest pressure that can be reached in the lungs when you take a deep breath. When you breathe through a device called a manometer, the device measures the pressure. The information is sent to a computer. The pressure level shows how strong the breathing muscles are.
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