Dyspnea: Struggling to Breathe
Dyspnea is the medical word for difficult breathing. People who experience dyspnea describe it as difficulty in breathing or shortness of breath. They often compare it to feeling like they are suffocating or being smothered. In many cases, people may develop anxiety or panic if they feel they cannot breathe. Often their anxiety and fears can make the dyspnea worse. By panicking, people can become more breathless and begin a cycle that is hard to stop.
Dyspnea is often treated with drugs such as bronchodilators, steroids, anti-anxiety drugs and pain medications. Oxygen is also often ordered by the physician. There are additional things that individuals can do to help minimize shortness of breath.
Relaxation exercises such as meditation may be helpful. This may also help reduce anxiety.
Pursed-lip breathing. To do this type of breathing, keep the lips pressed together tightly, except for the very center. Take normal breaths. Breathe in through the nose. Then take twice as long to breathe out through the center of your mouth. When you blow out, blow like you were making the flame of a candle flicker but don’t blow it out!
Diaphragmatic breathing (also called abdominal breathing). To do this type of breathing, you must first find your diaphragm. Here's how: Place your fingers just below your breastbone and breathe in. The muscle that moves is the diaphragm. You may find it useful to lie flat on your back and place a book on your abdomen so you can watch your breathing pattern as the book rises and falls. Your goal is to make the book rise and fall with each breath.
The tripod position, in which the patient sits or stands leaning forward with the arms supported, forces the diaphragm down and forward and stabilizes the chest while reducing the work of breathing.
Sleep may be easier if in a more upright position (lessening abdominal pressure on the lungs thus easing respirations). Using more pillows in bed. Put the head of the bed up or even sleep in a lazy boy chair if that makes it more comfortable and easier to breathe.
If the person reports increased dyspnea when performing activities of daily living (ADLs), especially when raising the arms above the head, recommend supporting the arms during ADLs, as by resting the elbows on a surface. This reduces competing demands of the arm, chest, and neck muscles needed for breathing.
Identify the person’s best “breathing time” of the day, and recommend reserving strenuous activities for this period.
Avoid environmental triggers of dyspnea, including temperature extremes and exposure to air pollution, pollen, cigarette smoke, chemical fragrances, and dust.
People with dyspnea commonly have problems maintaining adequate nutritional intake. Shortness of breath results in an increase in respirations thus burns more calories than normal to sustain those respirations. To improve nutritional status, eat small, frequent meals high in protein and avoid gas-producing foods. Monitor weight and food intake to make sure you are eating enough. If necessary, ask your doctor about using high-calorie nutritional supplements.
People who need oxygen therapy need to follow their doctor’s orders regarding the use of O2. Changing the oxygen level delivered will not necessarily help during a dyspneic episode. Instead, relax and do pursed lip breathing to slow down your respirations and get rid of the CO2 that has built up in your system. Use your oxygen all night, every night. If the nasal cannula falls off during sleep, don’t worry about it but do try to use it all night. You will wake up feeling more refreshed. Always use your oxygen for at least a half hour before any strenuous activity such as bathing or eating. It will help build some oxygen reserves in your system to get through that activity without shortness of breath.
Psychosocial concerns for people with dyspnea include increasing dependence on others, lack of control over symptoms, and decreased energy. Also, they’re at high risk for depression and anxiety because of symptom burden and functional limitations. These problems can affect their social interactions, role perception, and physical abilities. Understanding the issue and helping them verbalize their feelings and develop healthy coping behaviors can help lessen the psychosocial impact. However, know that as increasing dyspnea makes talking more difficult, conversation may grow burdensome.
Energy-conservation is the key to managing Dyspnea. Pace activities, take frequent rests, use assistive devices, and break activities into smaller tasks to help reduce dyspnea development.