Breathlessness

Many people with lung cancer have difficulty breathing before or after diagnosis. This shortness of breath is also called breathlessness or dyspnoea.

Learn more about:

• What causes it?
• How breathlessness is managed
• Having a pleural tap
• Ways to control fluid around the lungs
• Improving breathlessness at home

What causes it?

It can occur for several reasons, including:

• the cancer itself and lungs not working as well
• drop in fitness level due to less physical activity
• build-up of fluid (pleural effusion) in the pleural cavity, the space between the 2 layers of thin tissue covering the lung
• lung tissue changes after radiation therapy (radiation pneumonitis)
• other respiratory conditions, such as COPD.

How breathlessness is managed

If the cancer is blocking a main airway, a laser, stent (a metal or plastic tube) or radiation therapy may help open the airway and make breathing easier. You may also be referred to a pulmonary rehabilitation program to learn how to manage breathlessness.

This program will include exercise, breathing techniques, ways to clear the airways, and tips for conserving energy. Some people also use supplemental oxygen at home.

If you smoke or vape, your doctor will recommend you quit and suggest ideas for how to do this.

See tips to manage breathlessness at home.

Having a pleural tap

For some people, fluid may build up in the pleural cavity, the space between the 2 layers of thin tissue covering the lung. The build-up of fluid is called pleural effusion. This can put pressure on the lung, making it hard to breathe. Having a pleural tap can relieve this symptom. This procedure is also known as pleurocentesis or thoracentesis.

To drain the fluid, your doctor or radiologist numbs the area with a local anaesthetic and inserts a hollow needle between your ribs into the pleural cavity. It then takes about 30–60 minutes to drain the fluid.

You usually don’t have to stay overnight in hospital after a pleural tap. A sample of the fluid is sent to a laboratory for testing.

Ways to control fluid around the lungs

If breathlessness is caused by pleural effusion, you may need to have surgery.

Types of procedures include:

• pleural tap to drain the fluid
• pleurodesis to stop fluid building up again
• an indwelling pleural catheter.

Pleurodesis

Pleurodesis is a way to close the pleural cavity. Your doctors might recommend this procedure if the fluid builds up again after you have had a pleural tap. It may be done by a thoracic surgeon or respiratory physician in one of two ways, depending on how well you are and what you would prefer.

VATS pleurodesis – This method uses a keyhole approach called video-assisted thoracoscopic surgery (VATS). You will be given a general anaesthetic, then the surgeon will make one or more small cuts in the chest and pass a tiny video camera and operating instruments through.

After all fluid has been drained, the surgeon then injects some sterile talcum powder into the pleural cavity. This causes inflammation that helps stick the 2 layers of the pleura together and prevents fluid from building up again. You will stay in hospital for a few days.

Bedside talc slurry pleurodesis – If you are unable to have a general anaesthetic, a pleurodesis can be done under local anaesthetic. A small cut is made in the chest, then a tube is inserted into the pleural cavity. Fluid can be drained through the tube into a bottle.

Next, sterile talcum powder mixed with salt water (a “slurry”) is injected through the tube into the pleural cavity. Nurses will help you move into various positions every 10 minutes to get the talc slurry to spread throughout the pleural cavity. The process takes about an hour.

A talc slurry pleurodesis usually requires a stay in hospital of 2–3 days. After the procedure, some people feel a burning pain in the chest for 1–2 days, but this can be eased with medicines.

Indwelling pleural catheter

An indwelling pleural catheter is a small soft tube used to drain fluid from around the lungs. It may be offered if fluid keeps building up in the pleural cavity making it hard to breathe, or if you are unable or do not want to have a pleurodesis. The catheter can be in place permanently, or until it is no longer needed.

You will be given a local anaesthetic, then the doctor makes 2 small cuts in the chest wall and inserts the catheter into the pleural cavity. One end of the tube is inside the chest, and the other is coiled and fixed outside your skin with a small dressing.

The fluid can be drained at home. When fluid builds up and needs to be drained (usually once or twice a week), the catheter is connected to a small bottle. A community nurse can drain the fluid for you or they can teach you, a family member or friend how to drain the catheter.

→ READ MORE: Improving breathlessness at home

Now I have good and bad days. I do breathing exercises during rehabilitation. Sometimes I feel so good that I overdo it. I forget that I have one lung and I tire easily. I’m learning to pace myself.

Lois

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