Breathlessness
Cancer and its treatments may cause breathlessness. There are different ways to help manage breathlessness.
What is breathlessness?
Breathlessness is sometimes called shortness of breath. It is also called dyspnoea (pronounced dis-nee-a). It can be a symptom of cancer, or a side effect of treatment.
Breathlessness affects everyone differently. It may happen suddenly, but only last for a short time, for example hours or days. This is known as acute breathlessness. Or it can happen gradually and last for several weeks or more or keeps coming back. This is known as chronic breathlessness.
Signs and symptoms of breathlessness include:
- uncomfortable or fast breathing
- a tight chest
- using the neck and shoulder muscles to pull more air in
- feeling anxious or frightened.
Contact your doctor straight away if:
- breathlessness is a new symptom
- you have pain when you breathe
- the breathlessness gets worse quickly.
You may need urgent treatment. If you cannot speak to your doctor and your breathlessness continues to get worse, go straight to your nearest A&E (emergency department).
Related pages
Booklets and resources
Causes of breathlessness
There are different causes of breathlessness. Your cancer doctor will look at your symptoms to find out what may be causing it. This will help them find the best treatment or ways of managing it.
Your doctor will usually ask some questions about your health and how your breathlessness affects you. They will examine your chest and tummy. They usually ask you to complete a breathlessness scale. For example, they may ask you to complete the Medical Research Council (MRC) breathlessness scale to help measure your breathlessness. This can help them understand how much support you need.
You may have 1 or more of the following:
- chest x-ray
- CT scan
- lung function test
- blood test.
Different causes of breathlessness include:
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Cancer affecting the lungs
This can be cancer that started in the lungs (primary lung cancer) or cancer that has spread to the lungs from another part of the body (secondary lung cancer).
Treatments such as radiotherapy or chemotherapy may help shrink the tumour and relieve breathlessness caused by the cancer. We have information about different types of cancer and treatments you may have.
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A build-up of fluid in the lining of the lungs (pleural effusion) or abdomen (ascites)
If cancer cells irritate the lining of the lungs or tummy (abdomen), this can cause fluid to build up. This means there is less room for the lungs to expand.
Pleural effusion or ascites are treated by draining the fluid.
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Low levels of red blood cells (anaemia)
Red blood cells carry oxygen around the body. If the level of red blood cells is low, this is called anaemia. It can make you feel tired and breathless.
You may need a blood test to check if you are anaemic. Some people may need a blood transfusion.
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Chest infections
This can cause phlegm (mucus) in the airways and make you feel breathless. Contact your cancer doctor straight away if you have a high temperature (above 37.5°C or 99.54°F), a chesty cough or pain when you breathe. You may need antibiotic treatment.
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Weakened muscles
In advanced cancer, the muscles that help breathing can become weak because of fatigue, lack of nutrition, weight loss and reduced physical activity. Cancer and some cancer treatments can also weaken muscles used for breathing.
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Pain
Pain can make it hard to breathe and move comfortably. If you have any pain, tell your doctor. They can make sure it is well controlled. There are different types of painkillers that can help.
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A blood clot in the lung (pulmonary embolism)
This can cause sudden breathlessness, or coughing when you breathe. Contact your cancer team or hospital straight away on the 24 hour number if you have any of these symptoms.
A blood clot is serious, but it can be treated with drugs called anticoagulants that thin the blood.
Always call 999 if you have chest pain or difficulty breathing.
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Other conditions
Other conditions, such as chronic obstructive pulmonary disease (COPD), can cause breathlessness. Your doctor can advise you about the treatment you need.
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Smoking tobacco
Smoking makes breathlessness worse. The smoke irritates and inflames the airways. If you want to stop smoking, ask your specialist nurse or cancer doctor for advice or find out if there is a free NHS Stop Smoking Service near you. We also have information about giving up smoking.
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Anxiety and panic
Anxiety can make you breathe too fast and take shallow breaths from the top of the lungs rather than the lower chest. Breathing this way can make you feel more breathless, which can make you feel more anxious. Breathing and relaxation techniques can help break this cycle.
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Cancer treatments
Surgery for lung cancer, radiotherapy to the chest and some cancer drug treatments can sometimes cause breathing problems. Your cancer team will explain if your treatment may cause this side effect and what symptoms to look out for.
Managing and treating breathlessness
If you have breathlessness, there are ways to manage it and treatments that may help. These may include:
- breathing exercises and relaxation techniques
- using a handheld fan
- medicines and other help for breathlessness
You can also try the following things.
Keep a diary
You might find tasks are easier at certain times of the day. It can help to keep a diary to see any patterns. It can help to write down:
- when your breathlessness is difficult
- activities that make it worse
- times of day that you have more energy
- what techniques you use to deal with it.
You can use a diary to plan ahead and do things when they might be easier for you.
Making a plan
You may find it helpful to have an action plan for breathlessness. Write down a simple plan of what you will do when you are breathless. For example, this could be using a relaxation technique that you have learnt.
Have your plan nearby. Reading it can help reassure you of the steps you need to take to help you.
The Cambridge Breathlessness Intervention Service has more information on breathlessness including an example of an action plan.
Related pages
Who can help
It is important to know who to contact if you need information or support with breathlessness.
Ask your cancer doctor or specialist nurse:
- who you should contact.
- how to contact them, including at night, on bank holidays and at weekends
- when you should call for help or advice.
Many people are available to help you and your family and friends manage the problems that breathlessness can cause. These include:
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Clinical nurse specialist (CNS)
A clinical nurse specialist gives information about cancer, and support during treatment. They can refer you to other members of the healthcare team, to help you manage your breathlessness. They can also help you find support groups in your area.
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Physiotherapist
A physiotherapist gives advice about exercise and mobility. They can help you learn breathing techniques and relaxation and show you new ways of doing daily activities.
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Occupational therapist (OT)
They can give information, advice and support. They can help you find ways of doing things at home safely without getting too breathless.
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Dietician
They can give advice to make eating easier when you are breathless. They can also suggest changes to your diet.
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Social worker
A social worker can help with practical and financial problems. They are also trained in offering emotional support. You can request help from a social worker yourself by contacting your local social services department. Find your local council on the GOV.UK website.
Community support
Different people can offer support in the community. District nurses (also called community nurses) give advice and support to people by visiting them at home. They work closely with GPs.
Specialist nurses called palliative care nurses help with symptom control. They are sometimes called Macmillan nurses. They can offer you practical and emotional support. They can also visit you at home and support you and your family.
Some palliative care nurses are linked to the local hospice. Your GP can usually arrange for you to be seen by a specialist nurse at home.
If you have a local cancer centre, they may also have a hospice or a community specialist palliative care team that can offer you specialist help with your breathing.
Marie Curie nurses give palliative care and support to people by visiting them at home. They give nursing care during the day and overnight. You can talk to your district nurse or GP about whether a Marie Curie nurse is suitable for you.
Breathlessness clinic
Some hospices and hospitals have special clinics to help you manage your breathlessness. Your GP or someone from your cancer team can let you know if there is a service in your area. Talk to your healthcare professional for further information.
Managing everyday activities
It is good to keep active but when you are breathless, even normal activities can feel overwhelming. You can ask to see a physiotherapist or an occupational therapist (OT) for some expert help with this. Some of the following tips may also help.
Around the house
- You may be eligible for grants to make changes to your house or for extra equipment that can help. An OT or physiotherapist can also give you practical help and advice.
- Think about ways to arrange your home to make tasks easier. For example, it might help to put a chair in a hallway or landing, so you can rest when walking between rooms.
- Arrange your kitchen so the things you use most often are at waist height. This means you do not have to bend or stretch to reach cupboards.
Getting dressed
- Sit down when you are getting dressed. Choose loose-fitting clothes, especially around the waist and chest.
- Bring your feet up to put on socks, tights and shoes, as bending at the waist can make you breathless. Some people like to place their foot on a box or stool to help.
- Slip-on shoes are easier to get on and off.
Having a bath or shower
Keep the water warm but not too hot, as this can make you breathless. To get into the bath, sit at the side and slowly lift in one leg at a time. After your bath, you may find it easier to kneel first and rest for a few moments before standing up.
If there is enough space in the shower, sit safely on a seat or stool.
Going to the toilet
Grab rails and a raised toilet seat can make going to the toilet easier. An OT can visit and suggest adaptations to your home to make things easier. If you are constipated (have problems pooing), get this treated quickly. Constipation and straining can make breathlessness worse.
Diet
You may find that breathlessness can cause problems with eating. If you are not managing to eat enough, you can add calories to your food with high-protein powders or you can try high calorie drinks. Your GP or dietician can prescribe these for you. They are also available from most chemists. You can ask to be referred to a dietitian at your hospital. If you are at home, your GP can arrange this for you.
Here are some other tips:
- If you can, sit up at a table to eat as breathing may feel less restricted.
- Smaller meals on a smaller plate are easier to manage.
- Try to avoid chewy food. Eat slowly and take smaller mouthfuls.
- Try adding sauces or gravies to make food easier to eat. Take sips of fluid often.
- On days when making food feels too difficult, ready meals can help.
Dry mouth
Being breathless can make you breathe through your mouth more than your nose. This can make your mouth and tongue dry.
Here are some things that might help:
- If your tongue is ‘coated’, it may make your food taste unpleasant and put you off eating. If this happens, talk to your healthcare team for advice.
- Try sucking ice cubes or ice lollies.
- Tell your doctor about your dry mouth. They can prescribe mouthwashes, lozenges or saliva-like sprays or gels to help.
- Use lip balm for dry lips. But do not use lip balm if you are having radiotherapy to the head or neck area.
We have more tips to help with a dry mouth.
Sex and breathlessness
You may be worried about how being breathless may affect your sex life. If you have a partner, they may also be thinking about this. Sex takes energy and is tiring for the heart and lungs. Here are some tips that may help:
- Be open with your partner about your worries and what may help. This can help you both enjoy a fulfilling sex life.
- Talking, hugging and touching are all important parts of intimacy that do not take too much energy.
- Try to have sex when you are feeling rested, and your breathing is at its best.
- Some positions use less energy. You may need to try different positions to find what suits you best. Asthma and Lung UK has illustrations of suggested sexual positions for people with breathlessness.
- Sex after a big meal or alcohol might be more difficult, as your stomach will be full. Alcohol can also affect your sexual function.
- If you feel breathless while having sex, pause and take a few deep, slow breaths from your lower chest. Do this rather than completely stopping.
- Speak to your GP or specialist nurse if you want more advice. They can refer you to a sexual health counsellor.
Going out
If you are planning a day out it may help to get some information before you go. You might want to find out about lifts, parking, transport links, and how far you will have to walk.
Taking a small bottle of water with you can help with a dry mouth or coughing. You could also keep a handheld fan with you to help if you get breathless.
Some people find that when the air is cold outside, it can help to put a light scarf across their nose and mouth. This warms the air they breathe and adds moisture to it.
When you are walking outside, go slowly and use relaxed tummy breathing. It may help to match your breathing to your steps. You can do this by:
- breathing in on 1 step
- breathing out on the next 2 steps.
A walking stick, walking frame, wheeled walkers or wheelchair can be useful when you are outside, particularly for longer trips. Your nurse, physiotherapist or OT can arrange these for you. You can also hire wheelchairs from the British Red Cross. There is a charge for this service. Your local shopping centre or supermarket may also have wheelchairs you can borrow while you are there.
Your feelings about breathlessness
Your feelings may change over time. Some days you may feel scared, angry and sad. These are normal responses to breathlessness, cancer, treatment and any fears you have about the future. There is no right or wrong way to deal with these feelings, but accepting they are normal will help.
Sometimes you may feel you need to be alone. Other times you may want to be with people. Do what feels right for you at the time. You may have family and friends who find your changing emotions hard to understand. But try talking together about how you all feel.
You may find it helpful to talk to other people who are going through similar experiences. You can also share your experiences of breathlessness with other people on our .
You can also talk to your doctor or nurse for support.
Related pages
Feeling isolated
People with breathlessness can sometimes become isolated if it is hard for them to go out and meet family or friends. Talking in a big group of people can also be tiring.
If you do feel isolated, talking to family and friends can help. Tell them how you feel and how much you can do. Together, you can find a way to see each other that is less tiring for you.
Studies have shown that singing regularly as part of a group can help reduce feelings of isolation. Singing is also good for people living with long-term breathlessness. It can help you:
- breathe more deeply and slowly
- have more control over your breathing
- improve your posture.
Asthma and Lung UK has more information on singing and lung health, including how to find a group in your area.
Looking after someone with breathlessness
Looking after someone with breathlessness can cause many different feelings. The person looking after you may feel anxious to see you breathless. They will want to know how to help. They may feel isolated as they are spending more time looking after you.
It is important that the person looking after you takes time to look after themselves so that they can better support you.
We have more information about looking after someone, including information about having a carers assessment to see what help you might need.
Supporting Breathlessness has more information for family, friends and carers of people with breathlessness.
About our information
This information has been written, revised and edited by Macmillan Cancer Support’s Cancer Information Development team. It has been reviewed by expert medical and health professionals and people living with cancer.
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References
Below is a sample of the sources used in our breathlessness information. If you would like more information about the sources we use, please contact us at informationproductionteam@macmillan.org.uk
- European Society for Medical Oncology. Management of Breathlessness in Patients with Cancer: ESMO Clinical Practice Guidelines. 2020. Available from www.esmo.org/guidelines/guidelines-by-topic/esmo-clinical-practice-guidelines-supportive-and-palliative-care/management-of-breathlessness-in-patients-with-cancer [accessed March 2023].
- Sparathis A, Booth S, Moffat C et al. The Breathing, thinking, functioning clinical model: a proposal to facilitate evidence-based breathlessness management in chronic respiratory disease. NPJ Primary Care Respiratory Medicine. 2017;27:27 Available from 10.1038/s41533-017-0024-z [accessed April 2023].
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