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Palliative cancer care - dyspnoea - Management
What simple measures may help dyspnoea in palliative care?

  • Simple measures to relieve symptoms include:
    • Keeping the room cool.
    • Improving air circulation with a fan (directed towards the face, especially over the nose and mouth) or open window.
    • Trying relaxation and breathing techniques.
    • Providing reassurance that pain and distress will be controlled and explaining dyspnoea and its underlying cause, if known, to the person and their family.
  • Encourage exercise within the person's capabilities.
Clarification / Additional information
  • Controlled breathing techniques include positioning, pursed-lip breathing, breathing exercises, and coordinated breathing training [Doyle et al, 2004]:
    • Relaxing and dropping the shoulders reduces the 'hunching' that comes with anxiety [Regnard and Hockley, 2004a].
    • Sitting upright increases peak ventilation and reduces airway obstruction [Regnard and Hockley, 2004a].
    • Leaning forward with arms bracing a chair or knees with the upper body supported has been shown to improve ventilatory capacity [Doyle et al, 2004].
    • In pursed-lip breathing, people inhale through their nose for several seconds with their mouth closed, then exhale slowly through pursed lips for 4–6 seconds. This can help to relieve perception of dyspnoea during exercise or whenever dyspnoea is triggered [Doyle et al, 2004].
    • Breathing retraining aims to help the person regain a sense of control and improve respiratory muscle strength. It is facilitated by physiotherapists and clinical nurse specialists [Regnard and Hockley, 2004a].
    • For more information on techniques to help breathing, see Patient information on breathlessness.
  • Encourage exertion to the point of breathlessness to increase tolerance and maintain fitness:
    • The level of physical activity that is realistically achievable will vary from person to person. For example, people with very limited mobility may be able to stand up only once every hour or move their feet a few times an hour [Booth, 2006].
  • Consider management of other physical symptoms and the general psychological, social, and spiritual needs of the person and their family. See the CKS topic on Palliative cancer care - general issues.
  • Consider multidisciplinary assessment of the person and their family [Lothian Palliative Care Guidelines Group, 2004a].
  • Discuss adaptations in activities of daily living and lifestyle expectations and involve other professionals to identify where additional support is required [Davis, 1997; Twycross and Wilcock, 2001]:
    • Help the person adapt to their new respiratory capacity (e.g. review demands on mobility) [Regnard and Tempest, 1998].
    • Suggest pacing of activities by doing the same things, but at a much slower rate [Booth, 2006].
    • Offer access to patient groups, day care facilities, and respite admissions, depending on the needs of the person and their family [Twycross and Wilcock, 2001].
Basis for recommendation

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