Ten tips for managing breathlessness

Breathlessness is a very common symptom in long-term conditions. Living with breathlessness can be difficult, however the advice in this leaflet can help.

1: Cool your face

Research shows that cooling the skin around the cheeks, nose and mouth may ease breathlessness. To cool these areas some people open a window. You can also use a handheld fan, a cool flannel or cool water mist spray, even if you use oxygen. If you use a face mask, try cooling the sides of your face, forehead, neck and upper chest.

How to use a hand-held fan

• Find a comfortable position (see tip 2).
• Hold the fan about 15cm / 6in away from your face.
• Aim the air towards your face with the fan moving slowly left to right.
• Do this until you feel your breathing become easier.

2: Find your comfortable position

Certain positions may help breathing feel easier. Experiment with different positions until you find what works best for you. If possible, relax your neck, shoulders, upper chest, arms, wrists and hands. Leaning forward or sleeping in a more upright position using pillows, a pillow rest or an adjustable profiling bed may help.

3: Try to breathe from your tummy

Relaxed tummy breathing can make breathing feel easier because it brings air into the base of your lungs, where there is more room, and requires fewer muscles to breathe.

Tummy breathing can take time to learn; it does not always come naturally. Practice it little and often when you are not breathless. Eventually it can become a habit.

How to breathe from your tummy

• Find a comfortable, supported position in which you can relax.
• Breathe in and out through your nose, if comfortable.
• Relax your neck, upper chest, shoulders and tummy muscles.
• Place one hand on your tummy.
• Notice your tummy gently expand under your hand as you breathe in.
• Relax your tummy as you breathe out.
• Rest after the breath out and allow the next breath to come in its own time.

Additional tip: When breathless or worried, calm your breathing by taking slower, longer breaths from your tummy. Think ‘Breathe low and slow, relax, let go’.

4: Breathe around a rectangle

Breathlessness can make you feel you need more air, so the natural tendency is to try to take deep breaths in. This is not harmful, but it can make it feel harder to breathe as the lungs become full of air. Breathing around a rectangle encourages you to take a longer breath out, which then creates space for the next breath in.

Look for a rectangle shape near to you; perhaps a TV, or a door, or a picture. Trace around the rectangle with your eyes; breathe in on the short edge and out on the long edge.

Gradually slow the speed at which your eyes move around the rectangle and at the same time slow your breathing.

Additional tip: Some people find that breathing out through narrowed / pursed lips slows the breath out, which allows more time for the air to leave the lungs.

5: Find ways to manage anxiety or worry

Breathlessness can often feel uncomfortable and worrying. The areas of the brain triggered by breathlessness also process our emotions. Finding ways to manage these emotions can help ease the breathing.

How to manage anxiety or worry

At a time you feel calm try to identify:

• What things make you feel anxious or worried. Is there anything that you can change about this?
• Any physical sensations or thoughts that happen when you feel worried.
• Techniques that help make you feel better (this might be relaxation, distraction, talking to someone etc). Write these down to help you remember them when you need them.
• Talk about how you are feeling with a relative, friend or healthcare professional.

Additional Tip: Address worries one at a time, with support if needed.

6: Relax tension in your body or mind

Relaxation aims to reduce muscle tension, which can help breathing return to a more comfortable resting pattern.

Mindfulness aims to bring our focus to the ‘here and now’ to allow the body and mind to take a break from unhelpful thoughts.

At first, it can feel strange to relax or be mindful, particularly if we have felt worried, stressed or tense for a long time. Over time and with daily practice, relaxation and mindfulness get easier and become more effective.

Try one of these short exercises if you feel worried or anxious:

Tranquillity (Thew, 2008)

Think about the word tranquillity,

Say tranquillity three times in your mind,

Think about a colour associated with tranquillity,

Imagine all the things that this colour reminds you of,

Now imagine yourself in a place that brings a feeling of tranquillity,

What does it smell like in this place? What can you hear?

Enjoy this feeling of tranquillity.

5 4 3 2 1 technique

7: Have an action plan

When very breathless it can be hard to remember the techniques that will help, especially if you begin to feel worried or panicky.

Having a written action plan at hand may help – see our example action plan below. Create your own action plan using the techniques you have identified are helpful.

Action Plan

I have had this feeling before – I know it will go away soon.

I am going to drop my shoulders and use my fan.

I am focussing on gently breathing out.

I can do this – I am doing it now.

I don’t need to be frightened – I am OK.

8: Try to keep active

Breathlessness is such an unpleasant sensation it is natural to try to avoid it by becoming less active. However, this can lead to muscles becoming weaker and reduced fitness.

It is important to remember that it is not harmful to become moderately breathless through being active. Regular activity such as walking outdoors or indoors can help maintain fitness, if this is something you are able to do.

9: Conserve your energy

Many people with breathlessness experience low energy levels. To help energy last as long as possible, it can help to slow and pace yourself during activity.

In particular, slow down when you talk or eat as these actions can affect your breathing pattern.

How to conserve energy

• Break your activities down into smaller tasks that feel more manageable. and plan the best time of day to do them.
• Keep things you use frequently close to hand.
• Move at a slower or comfortable pace and avoid holding your breath.
• Breathe out on exertion such as standing up (‘blow as you go’).
• Stop and rest during activity whenever you need to.
• Sit down to do activities such as showering or preparing food.
• Allow yourself some time each day to relax.
• Take frequent small meals and avoid foods that are difficult to chew.
• Drink sips of fluid frequently to avoid becoming dehydrated.

10: Try walking aids

Walking sticks and frames help with walking or balance issues. However, research has shown that using a walking frame can also reduce breathlessness and help people to walk further. A four-wheeled walker can provide a helpful seat to rest, while a walking stick provides a portable leaning post to stop and catch your breath.

Please talk to your healthcare team if you feel these may be helpful.

References

Thew, M, (2008) ‘Portable’ Relaxation for Everyday Living’ In: Thew, M & McKenna, J. (Eds) (2008) Lifestyle Management in Health and Social Care. Oxford: Wiley Publishing

Contact the Cambridge Breathlessness Intervention Service

Box 63, Elsworth House
Addenbrookes Hospital
Hills Road Cambridge
CB2 0QQ

Phone the Cambridge Breathlessness Intervention Service on 01223 274404 (Hours are Monday to Friday, 09:00 (9am) to 17:00 (5pm). Messages can be left at any time)

Email the Cambridge Breathlessness Intervention Service

If you wish to provide any feedback on the service or have cause for complaint, please contact:

Dr Ben Clark, Lead Consultant in Palliative Medicine
Telephone on 01223 274404
Email Dr Ben Clark, Lead Consultant in Palliative Medicine