Easing Your Breathing

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					                                                      •   Unsteadiness; dizziness

                                                      •   Thirst
                                                      •   Anxiety; panic
                                                      •   Eye strain; headache
                                                      •   Impatience; anger

                                                      •   Husky or soft voice
                                                      •   Shoulder stiffness
                                                      •   Decreased appetite
                                                      Breathing can be tolerable one minute and rough

                                                      the next. Episodes can be triggered by activity,
                                                      odors, weather changes, moist air, fatigue, an
                                                      illness or infection, depression, or an emotional
                                                      Mild dyspnea can stop you from doing some of the
                                                      things you normally do like climbing stairs or
                                                      Severe dyspnea can make you curtail many
                                                      activities and make ‘work’ out of fun activities such
                                                      as talking and eating.
                                                                     Causes of Dyspnea
                                                      Breathing trouble can be a consequence of
                                                      problems with the lungs, heart, kidneys, liver,
                                                      nerves, or muscles. Dyspnea is often expected with
                                                      lung disease, but it can be a part of many other
                                                      diseases, such as stroke, dementia, cancer, or
                                                      congestive heart failure.
      Northwest Wisconsin                             Emphysema – The air sacs in the lungs lose their
                                                      normal elastic nature. Fresh air can be breathed in,
           HomeCare                                   but the airways then tend to collapse and the fresh
                                                      air is trapped in the lungs. This diminishes the
                                                      room left for new fresh air. The muscles that help
Dyspnea: Defined as being hungry for air. It is       you breathe become weakened and tired by the
manifested as rapid inhalations and expirations.      steady work. Your body begins to use other
Breathing is labored and difficult and may even be    muscles to help you breathe, such as neck and
painful. It may feel like a smothering sensation or   chest wall muscles, but this too becomes
the inability to catch a good normal breath.          exhausting. There is no cure for emphysema, but
Dyspnea is commonly associated with audible           symptoms can stabilize or improve.
breath sounds without a medical instrument, an
anxious or distressed facial expression, mouth        Pulmonary fibrosis — The lungs and chest walls
breathing or gasping, dilated nostrils and obvious    are stiff and don’t allow for normal air exchange in
bluish discoloration around the oral mucosa and       and out of the lungs.
lips. Dyspnea is normal when due to vigorous work
                                                      Heart disease — A heart that is weakened by
or athletic activity.
                                                      disease isn’t able to properly pump blood through
The physical sensation and the emotional reaction     the body and fluids tend to back up into the lungs.
to the sensation blend to create an episode of
                                                      Cancer—Some cancers affect the ability of the
breathlessness that can be anywhere from
                                                      body to regulate the breathing or can interfere with
annoying to frightening.
                                                      the normal flow of air into and out of the lungs.
People with chronic breathing trouble can             Other cancers can diminish the ability of the body to
experience:                                           carry the fresh, oxygen-rich blood around the body.
• Chronic cough
                                                      Nerve or muscle diseases – People who have had
• Numbness or tingling                                strokes, who have ALS (Amiotrophic Lateral
• Upset stomach, nausea                               Sclerosis), or dementia sometimes have trouble
• Chest pain                                          moving the muscles that assist with breathing.
• Fatigue; tiredness in the legs; desire to lay
   down                                               The cause of the dyspnea may not be fixable,
• Congestion                                          but there are techniques and medicines that can
• Yawning                                             ease your breathlessness, stop the panic, and
help you catch your breath.                                    Irritable, anxious, so restless that you can’t
                                                               sit or lie still?
             What Does COPD Mean?
                                                        • What are your able to do?
•   COPD is a lung disease.                                    How far can you walk without stopping to
•   The airways that carry air to your lungs become            rest?
    narrowed and it becomes harder for you to                  How steady are you? Do you need a cane
    breathe.                                                   or walker?
•   There are tiny air sacs where the airways end in           How easy or hard is it for you to talk?
    your lungs.                                                Can you do housework? Bathe? Dress?
•   These air sacs don’t empty and your lungs feel      • How do you sleep at night?
    full when you have COPD.                                   Lying down?
•   Besides feeling short of breath, you may cough             How many pillows do you use?
    more often and cough up mucous.                            Sitting up in a recliner or easy chair?
•   Shortness of breath may keep you from doing         • How tired are you during the day?
    things you would like to do.                               Do you doze frequently?
                                                               Do you feel like you use all your energy to
                                                        • Do you have any trouble thinking clearly?
                                                        • What is the color of your skin?
                                                               A bluish tinge to your nose, fingertips, or
                                                        • What is the temperature of your skin?
                                                               Is it cool, clammy?
                                                        • How is your appetite?
                                                               Does it feel like it is work to eat?
                                                               What foods don’t appeal any more?
                                                               Do you feel full fast?
                                                               Do you get a bloated or gassy feeling after
                                                        • What does your chest look like?
            Assessing Your Dyspnea                             Is there a widening of spaces between the
People with long-term dyspnea do not always                    ribs?
complain of breathlessness—they have high                      A barrel-shape from years of air-trapping?
thresholds and they develop a new sense of ‘normal      • How do you look when you breathe?
breathing’.                                                    Do your shoulders raise up?
                                                               Does your whole chest move?
The best way for your home care or hospice nurse               Does your abdomen pump?
and your caregivers to assess your breathing status            Is there a bulging or retraction between the
is to ask you. The person who has trouble                      ribs?
breathing is the only one who can rate the ease or             Do you grimace with each breath?
difficulty of breathing.                                       Do you purse your lips when you breathe
A breathing scale is helpful to let your caregivers            out?
know how much trouble you are having at rest and        • What are your breaths like?
with activity.                                                 Fast or slow? Deep or shallow? Relaxed or
        0 = No difficulty breathing                            labored?
        1 = Very slight problem with breathing          • What does your heart beat sound like?
        2 = Slight problem with breathing                      Fast or slow? Loud or soft? Regular or
        3 = Moderate problem with breathing                    irregular?
        4 = Somewhat severe problem with                • What can be heard when someone listens to
             breathing                                      your lungs?
        5 = Severe problem with breathing                      A crackle indicating fluid?
        6-8 = Very severe problem with breathing               A wheeze indicating narrowed air
        9-10 = Maximum difficulty with breathing               passages?
                                                               A rub, snore, or rattle indicating a blockage
These are some of the things that your nurse will              of mucus, infection, or spasm in the
ask you about or look at to get a complete picture of   airways?
your breathing status.                                  • How many colds or lung infections have you
•   What is the position that is the most comfortable       had recently?
    for you ?                                           • Do you cough a lot? What do you bring up
•   What is your mood?                                      when you cough?
                                                        • Do you use oxygen to help you breathe more
    comfortably?                                                   •   Add high-potassium foods to diet.
•   Do you have chest pain?                                            Diuretics can sap the body of fluids and
•   Is there swelling in your feet or legs?                            potassium, which are critical for
•   Do you get headaches?                                              maintaining energy.
                                                                   •   Avoid stomach upset, which can
      Non-Medicine Ways to Treat Dyspnea                               compromise food intake, by taking
People who have trouble breathing become the                           bronchodilators at least one hour before
experts on their own dyspnea management. You                           meals.
should have maximum control over how to handle
your breathing on a day-to-day basis and when you                      Guidelines for Managing an
have an episode of breathlessness but here are                         Episode of Breathlessness
some suggestions that might work for you.
                                                           •   Get in the best position possible to ease
                Guidelines for Everyday                        breathing and expand the lungs:
•   Stop smoking and avoid exposure to smoke.                     If in bed—put head of bed up or use
•   Avoid exposure to any sprays (hairspray, bug                  several pillows.
    spray, perfume).                                              If seated—lean forward with head lowered
•   Wear loose clothing.                                          and feet wide apart on floor or stool. Fold
•   Use air conditioning and a dehumidifier.                      arms across a table or support on pillows or
•   Avoid exposure to people with colds, respiratory              rest elbows on knees.
    infections.                                                   If walking—lean hips against the wall with
•   Conserve your energy. Find the easiest way to                 feet apart and shoulders relaxed but bent
    do things.                                                    slightly forward.
      Pace yourself (i.e., climb a few steps at a time
      Eliminate unnecessary tasks.
      Take rests between activities.
      Decrease the amount of talking you do (if
      talking is hard).
      Be wary of activities that involve movement of
                                                           •   Open the window or blow a fan
      the arms (lifting, shampooing hair, dressing) -
                                                               directly at your face or have someone put a cool
      these activities tend to rob your breath.
                                                               cloth against your face. All of these things will
      Sit on a chair or stool for as many activities as
                                                               decrease the sensation of breathlessness.
                                                           •   Use pursed-lip breathing to slow rapid breathing
      Use a bath bench and hand sprayer for
                                                               and prevent the collapse of air passageways
      showering. Open the bathroom door or use
                                                               and consequent air-trapping.
      the exhaust fan to decrease the warm, moist
                                                                   Breathe in slowly through your nose for 1
      air in the bathroom.
      Keep frequently used items nearby to avoid
                                                                   Purse your lips as though you were going to
      unnecessary walking, bending, carrying, and
                                                                   Breathe out gently through pursed lips for 2
•   Eat to breathe. We also point out how diet can
                                                                   slow counts.
    affect lung capacity. We encourage patients to:
                                                                   Let air naturally escape out—don’t force.
         • Eat several small meals per day to cut
                                                                   Repeat this pattern until you are not short of
              down on the oxygen needed for
                                                           •   Have your caregivers help you achieve a quiet
         • Breath evenly, slowly while chewing.
                                                               environment to help you reduce your anxiety by
              Take breaks during the meal to
              conserve energy.
                                                                   A calm presence
         • Use a liquid supplement for breakfast
                                                                   Quiet music
              (rather than skip a meal) if your short of
              breath in the morning.
                                                                   Pressure or massage to your tense muscles
         • Avoid gas-forming foods. Bloating in the
              abdomen can make breathing even                           Diaphragmatic Breathing
                                                           Diaphragmatic breathing helps the diaphragm
         • Include extra protein whenever
                                                           move. The diaphragm is the large muscle
              possible to rebuild muscle mass. Many
                                                           underneath your lungs. This type of breathing
              of the illnesses that cause Dyspnea can
                                                           technique is helpful for some patients.
              also cause weakness, and a vicious
              cycle of decline. Building up muscle         Use diaphragmatic breathing during exercise and
              tissue can help a patient recover some       when you feel short of breath.
    •   Inhale. Sit comfortably in a                     •   Cough expectorants may be used to help you
        chair. Place one hand on                             cough up mucus from your lungs.
        your stomach and one                             •   Cough suppressants may be used to help you
        hand on your chest.                                  stop the cough to allow you to rest.
        Breathe air in through your                      •   Diuretics or water pills may be used to help get
        nose slowly. Feel your                               rid of excess fluids which may build up in your
        stomach grow larger.                                 lungs or legs or abdomen.
    •   Exhale. Breathe out slowly through pursed        •   Bronchodilators such as inhalers or updrafts
        lips. Feel your stomach muscles tighten.             may be used to help open up your air passages.
    •   Continue diaphragmatic breathing until you
        feel calmer and less short of breath.                    To use an inhaler: Stand or sit up
Conserve Your Energy:                                                     Take off the inhaler cap and shake
Learn how to pace your activates or do them in an                         the inhaler.
easier way. You will do m ore and be less short of                        Breathe out.
breath. A few examples are:                                               Put the inhaler in your mouth or just
□ Walk at a slow and comfortable pace                                     in front.
□ Do activities at a slow and comfortable pace                            As you start to breathe in, push
□ Do things sitting down                                                  down on the top of the inhaler and
□ Put things that you need in one place that is easy                      keep breathing in slowly.
   to reach                                                               Hold your breath for 10 seconds.
□ Use a bath stool or bench during bathing                                Breathe out. Repeat process if
□ Consider sponge bathing                                                 directed
□ Dress seating instead of standing
□ Consider the use of bedside commode                    An aero chamber device attached to the inhaler
□ Rest after you eat                                     may assist you if you have trouble breathing in all
□ Avoid shopping at busy times of the day                the medication. If you find it becomes too difficult to
□ Go to places that do not have a lot of stairs          use an inhaler, your physician may have you switch
□ Prepare for activities by resting first and using      to taking your bronchodilator medicine through an
   breathing techniques                                  updraft machine called a nebulizer. The machine
□ Ask for help when you need it                          changes the liquid medicine into a mist which you
                                                         can breathe in through a hand-held pipe or
Breathing Techniques                                     mouthpiece. A mask that can be strapped to your
• Breathing exercises and techniques can help            face may also be used—this is often a good
   you when you have trouble breathing.                  solution when it becomes too tiring to hold the
• They can help strengthen the muscles you need          mouthpiece for the 10 minutes it takes to breathe in
   when breathing.                                       all the medicine. Your home care or hospice nurse
                                                         will teach you how to set up the updraft machine.
Leaning forward often makes it easier to breathe.        •   Steroids may be used to reduce inflammation.
Sit at a forward angle with your elbows resting on       •   Anti-cholinergic medicines may be used to dry
your knees or a table.                                       up secretions.
                                                         •   Anti-anxiety medicines are often used to
“Pursed-lip breathing”
                                                             decrease anxiety, relax skeletal muscles,
Pursed-lip breathing helps you breathe the air out of
                                                             decrease restlessness, decrease irritability, help
your lungs better. This way you will be able to
                                                             you relax, help you sleep.
breathe in more air when you inhale.
                                                         •   Opiods (usually thought of as pain medicines)
Use pursed-lip breathing during exercise and when            are safe and effective for managing your
you feel short of breath.                                    dyspnea when the non-medicine techniques
  • Inhale slowly.                                           you’ve been using and your previously used
  • Exhale slowly and gently for 4-6 seconds,                medicines aren’t keeping your breathing at a
      while you “pucker” your lips (like blowing out a       comfortable level anymore.
                                                                 Opiods (such as hydrocodone, oxycodone,
        Using Medicine to Treat Dyspnea                          or morphine):
There are medicines that are available to help ease                     Relax your breathing.
your breathing. These can be used in addition to                        Stop the anxiety and panic.
using non-medicine techniques. Your home care or                        Decrease the sensation of
hospice nurse will keep in close touch with your                        breathlessness.
physician about what medicines may be needed.                           Decrease your awareness of muscle
•   Antibiotics may be used if your doctor suspects                     Ease the flow of blood from the
    you may have a lung infection.                                      heart so that fluid is less likely to
               back up into the lungs.
               Make the breathing muscles slow         A humidifier can be added to the oxygen source to
               down so that each breath can be         keep the oxygen moist so that your air
               more effective and you don’t get so     passageways do not dry out.
               exhausted.                              • You will be given a bottle of distilled water to
                                                          use to keep the water level within the well-
       Opiods can be used to help you get                 marked lines on the humidifier bottle.
       through an episode of breathlessness.           • The humidifier bottle should be washed with
       Opiods can be used before activities that          soap and water and rinsed thoroughly when
       you know cause you to be breathless (like          being refilled.
       showering, visiting, oreating) and can keep
       you more independent.                           Oxygen is usually delivered through a nasal
       Doses are started low and then increased        cannula—a long, slender plastic tube that runs from
       to the point where you report relief of your    the oxygen source to small prongs that fit into the
       breathlessness.                                 nostrils (following the curve of the nostrils
       If you are using the opiod frequently           downward). The tubing should then be positioned
       through the day, your physician may order       behind each ear, and adjusted below the chin for a
       a long acting pill that you can take 2 or 3     comfortable fit. A mask that straps around the head
       times a day to give you better relief.          can also be used instead of the prongs.
       There is also an opiod skin patch that can      • The nasal prongs or mask can be replaced
       be applied once every three days. You               weekly or if you wish, they can be washed with
       will still use a quick acting form of opiod         soap and water, rinsed and re-used for several
       (usually a concentrated liquid) that can            weeks. Refill supplies will be provided.
       give you relief within minutes.                 • Extension tubing up to 50 feet long can be used
       If you have pain and dyspnea together,              to allow you freedom to walk around the house
       you will need a higher dose of opiod to             while still getting an adequate flow of oxygen.
       fight both symptoms.                                Guard closely against tripping.

       Using Oxygen for Relief of Dyspnea              Your home care or hospice nurse can help prevent
Oxygen can reduce the workload on the heart, may       skin irritation.
allow you to do more, and it may make you feel less    • A water-based moisturizer such as KY Jelly (not
breathless. The decision of when to use oxygen             an oil-based moisturizer such as petroleum
should be based on your level of comfort. It can be        jelly) can be applied to the nostrils to ease
used all the time or just when you feel breathless.        dryness or to protect from rubbing.
                                                       • Gauze, lamb’s wool, foam rollers or cotton balls
Early in the process of a breathing problem, your          can be wrapped around the tubing if your ears
physician may wish you to start at a low dose of           get irritated or sore.
oxygen. You may need to increase that dose as
time goes on. Your home care or hospice nurse will     Some safety measures to remember:
coordinate this with the physician.                    • Store the oxygen away from heat or direct
Most people who need oxygen use a combination of       • Secure the oxygen tanks so that there is no
delivery systems—one for at home and one for              accidental tipping.
traveling out of the home.                             • No smoking or open flames within 10 feet of the
Your oxygen provider and your home care or                oxygen source.
hospice nurse will show you how to use the             • Keep oxygen equipment 5 feet away from
equipment that is chosen for you.                         electrical equipment.
The most common stationery system is a                 • Don’t use aerosol sprays (such as hair spray or
concentrator—an electrical device that pulls oxygen       furniture polish) near the equipment.
out of the air. It has to be plugged in to work, but   • Don’t use an extension cord with an oxygen
you will never run out of oxygen. Small tanks of          concentrator.
compressed oxygen will be made available for you       • The concentrator can be tucked out of the way
to use when you leave your home or if there is a          to decrease noise and warmth, but make sure
power outage.                                             there is good air flow around it (i.e., not in a tight
• The cabinet of the concentrator should be wiped         closet).
    down with a damp cloth and dried occasionally.     The oxygen provider should periodically be
• The air filter should be removed, washed with        checking your equipment to make sure it is working
    soap and water, and replaced into the cabinet      properly. Refills should be provided in a timely
    weekly.                                            manner. Talk to your home care or hospice nurse if
Large liquid oxygen tanks can also be used to          there is a problem.
deliver your oxygen. Smaller portable tanks can be
refilled from the large tank.
                     Rate your breathing discomfort—at rest and with activity

                    0      1    2 3        4 5 6     7      8 9       10
                     No           Moderate       Severe         Maximum
                     Difficulty   Difficulty     Difficulty     Difficulty

               Describe what problems you are having with your breathing:
               What activities are difficult for you? What symptoms do you notice?

               Current oxygen

               Note weekly cleaning of concentrator filter and/or change of oxygen

                                 For additional copies of Easing Your Breathing
                                                 please contact:
                                       Northwest Wisconsin HomeCare
                                                  P.O. Box 2060
                                              Eau Claire, WI 54702
                                                 (715) 831-0100

1033E. 06/10

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