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.
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.
Also, the doctor may look at drugs the patient is already taking, as some drugs (such as ACE inhibitors for high blood pressure or heart failure) can cause cough.
(See the PDQ summary on Cardiopulmonary Syndromes for more information.)
Rattle occurs when saliva or other fluids collect in the throat and upper airways.
Rattle occurs when saliva or other fluids build up in the throat and airways in a patient who is too weak to clear the throat. There are two types of rattle. Death rattle is caused by saliva pooling at the back of the throat. The other kind of rattle is caused by fluid in the airways from an infection, a tumor, or excess fluid in body tissues.
Drugs may be given to decrease the amount of saliva in the mouth or to dry the upper airway. Since most patients with rattle are unable to swallow, these drugs are usually given in patches on the skin or by infusion.