Lung Cancer Shortness of Breath

A distressing symptom of lung cancer is shortness of breath, also called dyspnea. This may worsen as the cancer progresses. Dyspnea can be caused by various factors, including:

• Tumor growth/progression

• Accumulation of fluid in the chest cavity (pleural effusion)

• Infection

• Partial lung collapse

• Pneumonia

Patient Power spoke with Valsamo Anagnostou, MD, PhD, director of thoracic oncology biorepository and assistant professor of oncology in the Sidney Kimmel Cancer Center at Johns Hopkins, to learn more about why it happens, what the signs are, and what patients can do if they are experiencing this symptom.

Dr. Anagnostou listed the most common sensations that patients with shortness of breath may experience, which are:

• Difficulty catching their breath

• Tightness in the chest while resting or with exercise

• The need to breathe more quickly

• The need to breathe more deeply

• Wheezing when they breathe

Once a patient with lung cancer is found to have symptoms of dyspnea, a grading system may be used to classify the severity. “It can be mild, coming on only during strenuous exercise, but more commonly can be moderate and appreciable when hurrying on level ground or walking up a slight hill,” she noted.

“As shortness of breath progresses, patients may walk slower because of breathlessness or have to stop for taking a breath when walking at their own pace. With severe shortness of breath, patients are breathless during regular daily activities that do not require exertion.”

If you experience dyspnea, your physician will ask questions about your symptoms to attempt to classify the severity.

Grade 1

Breathlessness only occurs with strenuous exercise.

Grade 2

Breathlessness occurs when walking quickly or going up a slight hill.

Grade 3

Individuals walk slower than people of the same age or have to stop when walking to catch their breath.

Grade 4

Individuals must stop for breath after walking 100 yards or after a few minutes of walking on a level surface.

Grade 5

Individuals are too breathless to leave the house.

You may be wondering, how does lung cancer cause result in shortness of breath? There are many reasons.

Tumor growth/progression

“Shortness of breath in patients with lung cancer can be caused by tumor growth and progression, as the tumor takes up the place of normal airways (reduced normal lung volume),” said Dr. Anagnostou.

Fluid accumulation

Fluid buildup in the space between the lining of the lungs (pleural effusion) or in the space between the lining of the heart (pericardial effusion) can also restrict normal breathing,” said Dr. Anagnostou. She did note, however, that pericardial effusion is rare.

Infection

If parts of the lung are obstructed, they are prone to developing infection and can result in bronchitis or recurring pneumonia, which can also contribute to shortness of breath.

Atelectasis

“Even in the absence of an infection, these obstructed airways are not in good shape to perform gas exchange,” explained Dr. Anagnostou. “The patient can therefore feel short of breath because of the airway blockade (atelectasis).”

Blood clots

Shortness of breath can also occur in the event of a blood clot in the pulmonary vessels and from buildup of fluid between the lung and the ribs or the lining of the heart. All the conditions above are related to the cancer to an extent.

“A patient should seek medical attention with abrupt onset of shortness of breath, wheezing, [and/or] frequent respiratory tract infections that come back after a course of antibiotics,” said Dr. Anagnostou.

The good news is there are some strategies you can implement to help cope with this issue, whether through medications, procedures, or techniques you can do at home.

Of course, addressing the underlying lung cancer should always be part of the treatment plan. Other treatments will depend on contributing factors – such as, antibiotics if there is an infection present, removal of pleural fluid if necessary, or the use of blood thinners if there are blood clots in the lung.

“In terms of symptomatic control, relaxation techniques and use of a fan with cool air blowing on the face may help,” Dr. Anagnostou said.

“In case of difficulty with mobilizing secretions, there is some evidence to suggest that chest physical therapy (chest wall vibration) may be of benefit. If there is concurrent COPD (as many patients have a smoking history or are active smokers), bronchodilator therapy may be useful,” she added.

Finally, anti-inflammatory steroid therapy or placement of an airway stent (a mesh tube placed in the airway to hold it open) may be considered for cases in which there is airway obstruction by the tumor.

“It is important to understand that shortness of breath in a patient with lung cancer has different etiologies,” Dr. Anagnostou said, “and as such, requires different treatment tailored to the underlying cause, in combination with treating the lung cancer.”