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Managing Other Symptoms |
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 Shortness
of breath
"I feel very short of breath, as if I just can't breathe."
Depending on why you are short of breath, various procedures
may ease your breathing. Fluid that collects around the lung can be
drained through a needle. You may get relief from changing position,
being propped up on pillows, using oxygen, or shrinking a tumor with
radiation or steroids.
If you have mild, persistent shortness of breath that can't be treated
directly, you may breathe easier with a regular, low dose of opioids.
Opioids include morphine, oxycodone, dilaudid, and similar medications.
Although these medications are frequently prescribed for pain relief,
they also ease the feeling of being short of breath. Taking opioids
at bedtime can help you sleep comfortably and prevent you from waking
up fighting to breathe. Some patients get the same sort of relief
from drugs commonly used for anxiety.
Some doctors really resist using opioids for shortness of breath.
If your doctor is concerned, you might discuss what you learn in this
chapter and encourage a look at texts on symptom management. You might
also try just a low dose of medication for a few days (or a few bedtimes).
You may be able to try a medication in a situation where someone can
monitor any tendency to breathe less well effectively. This might
be in a hospital or when someone (family member or nurse) can check
on you after four and eight hours. This kind of a trial run might
be reassuring enough to you and your doctor.
Shortness of breath is a common symptom for people who are dying.
Many people have mild, persistent shortness of breath as they get
very sick. Some, however, have illnesses that make it likely that
they will die with much more severe or sudden shortness of breath
that does not respond to treatment to remove its cause. People with
chronic heart or lung disease often require more aggressive treatment
to relieve the distress. Some ilnesses, such as emphysema, are more
likely than others to make you feel as if you just can't catch your
breath. You may be afraid that you will feel as if you are suffocating,
but you should not feel this way. You do not have to fear a feeling
of suffocation, no matter how you die. This is an emergency situation
that you must be prepared for if you are likely to have significant
shortness of breath.
Hospice physicians agree that patients suffering in this way should
be given enough opioid, usually morphine, to relieve shortness of
breath, even if the patient becomes drowsy or unconscious. If you
are likely to experience severe shortness of breath at the end of
your life, make sure that your doctors and nurses will treat your
shortness of breath aggressively, even if it may lead to unconsciousness.
You may need to keep the medication in your home and have a way to
have it administered relatively quickly. If your doctors and nurses
are not comfortable with such a plan, you should consider looking
for another care team.
A Case Study
Frank James, a 67 year old retired bricklayer with severe emphysema,
called his doctor's office to see when Dr. Miller would stop by. Ever
since Frank got so short of breath that a doctor's office visit was
exhausting, Dr. Miller had been stopping by every month or so to do
his check ups at home. They had a firm understanding that Mr. James
would never again be put on a ventilator. Mr. James' sister, Clara,
lived with him and agreed to page Dr. Miller if there was a sudden
change or a bad episode. Thus, Mr. James was startled to hear the
receptionist say:
"Mr. James, Dr. Miller has had a health problem of his own. He's
arranged for a new doctor, Dr. Winchester, to take over his practice
until things get straightened out."
Dr. Winchester: "I see from Dr. Miller's notes that you have
firmly decided no to go back to the hospital for shortness of breath."
Mr. James: "That's right. My time is close. This life is okay,
but it's not great. When the angels come by next time, I'm going along."
Dr. Winchester: "What will you do?"
Mr. James: "I was supposed to page Doc Miller. What am I to
do without him?"
Dr. Winchester: "When you get really short of breath again,
do you want to have a drug to make you sleepy? Some people would worry
that you run a risk of dying more quickly. But if you can't breathe
you might rather be asleep than struggling. And if you are that short
of breath, you will probably fall asleep from the increased medicine
before you take enough to really hasten your death."
Mr. James: "Yeah. That's what Doc Miller said, too. He promised
I could have the medicine."
Dr. Winchester: "Let's see what I can do. I don't live nearby
like Dr. Miller. I can't be as sure that you can reach me quickly,
and I have two other doctors covering for me after hours."
After a few minutes of conversation, it turned out that Clara had
been a registered nurse and was comfortable with responsibility for
keeping and giving the medication. Furthermore, a good hospice in
the area was available to back her up. By the time Dr. Winchester
left, Mr. James and his sister were reassured that they had a good
plan, a caring doctor, and the opportunity to live fully in the time
remaining. Clara called her son and her prayer group to tell them
the good news. |
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Adapted from The
Handbook for Mortals: Guidance for People Facing Serious Illness,
by Joanne Lynn and Joan Harrold, copyright by Joanne Lynn, used by
permission of Oxford University Press.
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