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Last Days of Life (PDQ®): Supportive care - Patient Information [NCI] - Managing Symptoms

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Fatigue

Fatigue (feeling very tired) can have many causes at the end of life. These include physical and mental changes and side effects of treatments. Drugs that increase brain activity, alertness, attention, and energy may be helpful. (See the PDQ summary on Fatigue for more information.)

Shortness of Breath

Feeling short of breath is common and may get worse during the final days or weeks of life.

Shortness of breath or not being able to catch your breath is often caused by advanced cancer. Other causes include the following:

  • Build-up of fluid in the abdomen.
  • Loss of muscle strength.
  • Hypoxemia (a condition in which there is not enough oxygen in the blood).
  • Chronic obstructive pulmonary disease (COPD).
  • Pneumonia.
  • Infection.

The use of opioids and other methods can help the patient breathe more easily.

Very low doses of an opioid may relieve shortness of breath in patients who are not taking opioids for pain. Higher doses may be needed in patients who are taking opioids for pain or who have severe shortness of breath.

Other methods that may help patients who feel short of breath include the following:

  • Treating anxiety caused by shortness of breath.
  • Directing a cool fan towards the patient's face.
  • Having the patient sit up.
  • Having the patient do breathing and relaxation exercises, if able.
  • Using acupuncture or acupressure.
  • Giving antibiotics if shortness of breath is caused by an infection.
  • Giving extra oxygen if shortness of breath is caused by hypoxemia.

In rare cases, shortness of breath may not be relieved by any of these treatments. Sedation with drugs may be needed, to help the patient feel more comfortable.

Some patients have spasms of the air passages in the lungs along with shortness of breath. Bronchodilators (drugs that open up small airways in the lungs) or steroid drugs (which relieve swelling and inflammation) may relieve these spasms.

Cough

Chronic coughing at the end of life may add to a patient's discomfort. Repeated coughing can cause pain and loss of sleep, increase tiredness, and make shortness of breath worse. At the end of life, the decision may be to treat the symptoms of the cough rather than finding and treating the cause. The following types of drugs may be used to make the patient as comfortable as possible:

  • Opioids to stop the coughing.
  • Corticosteroids to shrink swollen lymph vessels.
  • Antibiotics to treat infection.
  • Bronchodilators to decrease wheezing and coughing from chronic obstructive pulmonary disease.
  • Diuretics to relieve coughing caused by congestive heart failure.
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