Symptom Specific Services

Shortness of Breath
• Will I have shortness of breath?
• How is shortness of breath evaluated?
• What are the underlying causes of shortness of breath?
• Why is it important to determine the cause of my shortness of breath?
• What kinds of questions will I be asked?
• What are the diagnostic techniques you use?
• How is shortness of breath treated?

Will I have shortness of breath?
Shortness of breath, known as dyspnea, is an uncomfortable awareness of breathing and can be a common symptom in cancer-related illnesses. Fifty percent of cancer patients complain of shortness of breath at some point, and 20 percent rate the symptom as moderate to severe. Shortness of breath causes patients to limit their activities, which leads to social isolation and decreased quality of life. At Continuum Cancer Centers of New York, we work to effectively assess and treat your shortness of breath to improve your quality of life.

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How is shortness of breath evaluated?
Shortness of breath is difficult to measure because it involves several feelings and presents itself differently in different patients. Shortness of breath depends on your age, condition, psychological state and underlying health causes. To evaluate shortness of breath, your health care providers will review how your related organs are functioning.

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What are the underlying causes of shortness of breath?
The causes of shortness of breath, related to specific organ functions, usually involve one or more of the following:

The Lung
Shortness of breath can be caused in the lungs due to:

• An infection in the lung, usually resulting in pneumonia or bronchitis.

• Cancer that has started in the lung or other parts of the body, and has spread to the lung. This can cause a fluid build up in the lungs known as a pleural effusion.

• Cancer that obstructs the bronchial tubes and blocks the breathing passageway.

• A blood clot to the lung, called a pulmonary embolus. This occurs more commonly with cancer in the glands (adenocarcinoma), such as breast cancer.

The Heart
Shortness of breath caused by decreased heart function can be due to:

• A tumor squeezing the heart, usually as a result of the cancer invading the pericardium, the membrane that surrounds the heart. This prevents the heart from pumping out more blood, and makes breathing difficult.

• An irregular heart beat, which leads to a reduction in the heart's output.

• Chemotherapy and/or radiation. Doxorubicin is the chemotherapeutic drug most commonly associated with heart damage.

Anemia
Shortness of breath associated with anemia is due to a shortage of oxygen in the blood.

Other Causes of Shortness of Breath
Chemotherapy drugs can cause lung and heart side effects that result in shortness of breath. Radiation delivered to the chest may damage the lungs. Anxiety or other emotional factors can also be factors that contribute to shortness of breath.

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Why is it important to determine the cause of my shortness of breath?
Your health care providers want to identify the cause of your shortness of breath so they can improve your breathing and quality of life. It is important to remember that shortness of breath is a complex symptom. To effectively assess this problem, your team of doctors and nurses will take into consideration more than just your physical symptoms. They will also consider aspects such as your level of anxiety and emotional distress.

Shortness of breath does not always indicate that oxygen levels are low. A chest X-ray, a CT scan of the chest, and other tests can help determine the cause.

The best way to identify the cause of shortness of breath is with a medical history and physical exam. The focus of the exam will be on symptoms of breathlessness, and your medical team will try to determine quality, intensity, duration, and change in breathlessness over time. The frequency and the amount of distress or discomfort will also be considered, as will be any coughing or chest pain.

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What kinds of questions will I be asked?

• How severe is your shortness of breath?

• How far can you walk without being out of breath?

• How has your breathing pattern changed over the past months? Weeks? Days?

• Is your shortness of breath associated with chest pains? Coughing? Wheezing?

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What are the diagnostic techniques you use?

Medical history and physical examination
We will make a visual inspection to see if your chest is rising and falling symmetrically. If it is not, there may be a blockage in a major airway. We will pay close attention to the breathing sounds, because marked distress or unnatural breathing patterns characterize some breathing disorders. Wheezing or crackling sounds are clear signs of an obstruction in the trachea, main bronchus, or other airway.

Chest X-ray
The lung and surrounding structures can be visualized on a chest X-ray. A CT scan of the chest is a more sensitive and specific method of determining the cause of shortness of breath. Sometimes, these tests can eliminate lung-related causes of shortness of breath, raising the possibility of other causes of breathlessness.

Bronchoscopy
Bronchoscopy is sometimes helpful in assessing whether the airway is obstructed.

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How is shortness of breath treated?
The treatment for your condition will depend on the cause(s) of your shortness of breath. If cancer is causing your shortness of breath, every effort will be made to treat the cancer through medications and other therapies. If the cause is an infection in the lungs, it can be treated with antibiotics.

If your shortness of breath is due to a problem with heart or lung functions, fluid can be drained from the lungs and, if there is evidence of a blood clot, your blood can be thinned. If there is fluid around the heart, it can be drained using a needle. If anemia is causing your shortness of breath, it can be treated with a variety of medications such as Procrit. For more information, see the section on fatigue.

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