Breathlessness (feeling short of breath) is a very common symptom in secondary breast cancer. The medical term for this is dyspnoea. When your body is not getting enough oxygen, your lungs work harder to try and draw in more air and in turn get more oxygen circulating around the body. This is what makes you feel breathless.
Breathlessness may be experienced when moving around or when at rest. It may feel as though as you cannot catch your breath or take enough air into your lungs and can be very distressing and frightening. Feeling anxious and frightened about breathlessness can in turn make it worse.
Coughing is another common symptom experienced by women living with secondary breast cancer, with a variety of potential causes. It may be associated with breathlessness and can have a significant impact on a person’s sleep and daily life.
In this section
- Causes of breathlessness
- Tips for coping with mild breathlessness
- Medications & physiotherapy
- Palliative support
- Relaxation & breathing exercises
Causes of breathlessness in secondary breast cancer
For women whose breast cancer has spread to the lungs, breathlessness can be caused by the cancer pressing on the airways or causing a build-up of fluid in the lungs. However, this is not just a symptom experienced by women with lung metastases. You may also experience breathlessness for many other reasons when living with secondary breast cancer, for example:
- As a side-effect of cancer treatments such as radiotherapy,
- low red blood cells (anaemia, often caused by chemotherapy),
- chest infection,
- persistent cough,
- blood clot in the lung,
- other health problems in the heart & lungs.
Radiotherapy targeting the chest can lead to breathlessness due to inflammation (the body’s response to injury or infection) of the lining of the lung (pneumonitis). For some people, this is only a short-term problem. Where radiotherapy is used in the longer-term, scarring of the lungs can occur and breathlessness can be ongoing.
Low red blood cells (anaemia)
Chemotherapy can cause you to have a low red blood cell count. This reduces the amount of oxygen which you are able to absorb in your blood, in turn making you feel breathless as the lungs try to draw in more oxygen-rich air. This usually causes more gradual breathlessness and tiredness over time and is worse when doing physical activity e.g. climbing stairs or walking up a hill.
When being treated for cancer, you may develop a chest infection. This causes a build-up of phlegm (mucus) in the lungs and airways, making it harder to breathe.
If you are coughing, bringing up mucus, and have a fever or high temperature, please contact your hospital immediately as these are signs of infection and you may need antibiotics.
A persistent cough (i.e. a cough that won’t go away) can be another common, distressing symptom experienced in secondary breast cancer. It may be the result of metastases (areas where breast cancer has spread) in the lung, chest infection or a viral cough. This can make breathing difficult and can be very tiring. In some cases, phlegm (mucus) may build up in your chest and be difficult to bring up.
Cough medicines bought over the counter may help to control your cough. Your doctor may also prescribe a medication to loosen the phlegm, or stronger medications such as steroids if your cough is particularly difficult to control. Speak to your doctor (or, if you have one, you breast cancer nurse) about the available options and before trying any over the counter treatments.
Blood clot in the lungs
A blood clot in the lung (known as a pulmonary embolus) can also develop when undergoing cancer treatment. This would cause more sudden and sometimes more severe breathlessness. It may also cause you to have pain in your chest when you breathe.
If you experience any of these symptoms please contact your hospital immediately.
Experiencing episodes of anxiety is very natural and common when living with secondary breast cancer. For some women, feeling anxious and panicked can make their breathing more rapid and shallow, causing them to feel breathless. Anxiety can also cause heart palpitations (the sensation of feeling your heart beating fast), dry mouth, sweating, feeling sick and dizziness. Some of the breathing and relaxation exercises discussed below can help you to manage and control anxiety.
Being in pain can make it difficult for you to move around and breathe properly, causing you to take shorter, shallow breaths. It is important to speak to your doctor or nurse about any pain you are experiencing, so that they can help you to manage it well and prevent it from affecting your physical and mental health.
Other health problems
Breathlessness isn’t always necessarily due to your cancer or treatment. You may have other health conditions such as asthma, chronic bronchitis or heart failure which cause you to feel short of breath.
Mild breathlessness is not dangerous but it can be very frightening. There are lots of things that you can do to help you cope.
Tips for coping with mild breathlessness
- Try to slow your breathing and take deep breaths. This can help to ease anxiety which may be worsening your breathlessness.
- Cool your face with cold water or a wet flannel.
- Sit near an open window. This can help ease your breathlessness by keeping the air flowing in the room.
- Hold a handheld fan up to your face and breathe out against the fan. This can help to slow and calm your breathing.
- Taking regular, gentle exercise can help you to control and ease breathlessness but it is important to speak to your doctor/nurse before trying this. If you breathlessness has been caused by a blood clot, a chest infection or anaemia (low red blood cell count) it is NOT advisable for you to exercise until these conditions have been treated.
- Maintaining a healthy weight can also help to prevent and ease breathlessness.
You may be prescribed a medication to help manage your shortness of breath.
Different medications can be used to treat different causes of breathlessness through a number of ways;
- Relieving anxiety which may be worsening breathlessness.
- Loosening any sticky phlegm (mucus) which may be clogging up the lungs and making it difficult to breathe.
- Reducing fluid which has built up in the lung, making it harder to breathe.
- Reducing inflammation in the lungs.
- Making the airways wider and increasing the flow of air into the lungs.
Your doctor or nurse will be the best person to advise you on any treatments that may be suitable to you and the sort of breathlessness you are experiencing.
Your doctor or nurse may refer you to a physiotherapist to help with you breathing. They will be able to teach you exercises to manage and relieve breathlessness.
Palliative care specialists are experts in the management of complex symptoms such as breathlessness and pain. They are able to provide you with lots of advice and guidance on managing your symptoms at any stage in your illness. Some people worry that palliative care is only offered when cancer is in its final stages but this is not the case. Asking for support from palliative care does not mean that you have to be admitted to a hospice. Some palliative care nurses are able to visit you at home, or you may visit a hospice as a day patient for support in managing your symptoms independently.
Speak to your doctor (or, if you have one, your breast cancer nurse) about the help your local palliative care specialists could provide you.
Relaxation & breathing exercises
It can be possible to slow your breathing by performing controlled breathing and relaxation exercises, which you can practice yourself at home.
Abdominal breathing is one controlled breathing technique which you might like to try.
- Position yourself comfortably in a chair or sat upright in bed, propping yourself up with cushions if needed.
- Begin to breathe gently.
- Place your hand flat on your tummy, just under your ribcage and breathe in gently. You will feel your hand rise up and out as air is drawn into your lower chest and back down again as you breathe out.
- In your head, count as you breathe. Count to two as you breathe in through your nose and count to four as you breathe out through your mouth. This means your breath out will be longer than your breath in. Focus on the rise and fall of your abdomen.
- Practice this exercise daily. Aim to do 10 breaths at a time, three times a day if you can. Some people find it useful to do even when they are not feeling breathless, as it can help you to feel more in control of your breathing when you do feel breathless.
Allowing your body and mind to relax can you to cope with a range of symptoms and side effects, including breathlessness.
There are lots of different relaxation exercises you can try.
Slow rhythmic breathing is one example;
- Take slow, deep breaths in through your nose and breath out slowly through your mouth, feeling your body begin to relax. Focus on the tension leaving your body with each breath.
- Continue to breath in and out slowly and deeply at a rate which feels comfortable for you. Try to breathe in for a slow count of three and out for a slow count of four.
- When taking a deep breath in, feel the breath travel all the way down to your stomach.
- Continue with this slow, rhythmic breathing for up to 10 mins or for as long as it feels comfortable for you.
- When you finish, end with a slow, deep breath
Macmillan also provide a range of information on relaxation, which you might find helpful.
Managing daily life with breathlessness
If you are dealing with breathlessness over a longer period of time, going about your day to day life can become very difficult. In order to stay as active as possible, it is important to find ways to stop yourself from getting too breathless. This may mean finding ways of doing things without using as much energy, so that you do not need as much oxygen.
Here are some simple tips for making daily living a little easier when coping with breathlessness.
The three P’s
Think about the activities and tasks that you have planned for the day or week ahead and decide which are most important to you and which could wait. Try to make sure you prioritise social activities too, as opposed to just work, family responsibilities or household chores. If you know a particular activity will use up a lot of your energy, try not to plan too much else for that day. Prioritising will allow you to use your energy in the most efficient way.
Plan how you will carry the activities and tasks which you have prioritised. Planning ahead can help you to use your energy more efficiently. Be realistic with what you plan to do and seek support from family and friends if you think you might need it. It is also important to remember to plan in periods of rest in your day.
Take your time when carrying out the things you have planned to do and remember that you don’t have to achieve everything at once. If you feel your symptoms are worsening, slow down and rest. If you are going out or have appointments to make, give yourself plenty of time so you don’t need to rush.
A persistent cough (i.e. a cough that won’t go away) can be another common, distressing symptom experienced in secondary breast cancer. It may be as a result of metastases in the lung, a chest infection or a simple virus such as a common cold. This can make breathing difficult and can be very tiring. Phlegm (mucus) may build up in your chest and be difficult to bring up.
Cough medicines bought over the counter may help to control your cough. Your doctor may also prescribe a medication to loosen the phlegm, or stronger medications such as steroids if your cough is particularly difficult to control. Speak to your doctor (or, of you have one, your breast cancer nurse) about the available options before trying any over the counter treatments.
Remember, it is always a good idea to discuss new symptoms that have lasted more than a week or two with your doctor or nurse.
Disclaimer: on this website you will find self-management advice to help you to manage a range of mild symptoms and side effects of secondary breast cancer and its treatment. Please ONLY use this advice if you are currently participating in the LIBERATE study. Otherwise, please follow the advice of your own healthcare team.
Page last updated: April 2020