Dyspnoea is a subjective experience of difficulty breathing. It is frightening and people experiencing it may say that they feel they are suffocating, short of breath, unable to get a breath, or drowning.
Nurses have an important role in recognising, assessing, and managing symptoms related to dyspnoea. They can also help patients and families with sensitive and culturally appropriate education and support.
dyspnoea describe their experience in a number of ways, for example:
Dyspnoea is a debilitating symptom with significant negative affect on a person’s quality of life:
These factors should be included in comprehensive assessment and management of dyspnoea. When combined they can further worsen breathlessness. For example, a person’s fear of no longer being able to breathe can fuel increased breathlessness through their anxiety. A person’s progressive deconditioning from inactivity, perhaps from avoiding exercise to avoid breathlessness and/or anxiety, can lead to increased breathlessness with movement.
It is important to
identify reversible (treatable) factors contributing to dyspnoea and to manage
them. These include bronchospasm, infection, heart failure, pleural effusion,
pulmonary embolism, anaemia, and large airway obstruction. Active treatment of
these may be appropriate.
Dyspnoea can be managed while
the cause(s) are being investigated.
Assessment should include physical, social, psychological, and spiritual factors.
Observe the person’s posture - trying to sit upright leaning forward with shoulders hunched up or leaning against something suggests the person is working hard to breathe.
Listening to the person’s experience of breathlessness can provide clues to triggers or predominant vicious cycle which can be addressed as a priority.
Tailor the assessment to the person’s ability to tolerate the assessment. Ask open-ended questions if you think that the person can answer them. If the dyspnoea is or becomes acute, use closed questions which can be answered with one word, a nod or a shake of the head. A family member or carer may provide more detail.
Asking the person about their breathing difficulties and how it is affecting them (physical, social, psychological, spiritual, function) is the best approach. As appropriate ask open questions such as:
Or closed questions:
Nurses might ask the carer:
Consider use of tools such as
The aim of care is to reduce the effect of breathlessness on the person’s life including activities of daily living and to improve their quality of life. Dyspnoea is a complex symptom. Its treatment often requires a multidisciplinary approach and a combination of non-pharmacological measures, and medicines (pharmacological measures). Chronic or distressing dyspnoea can serve as a trigger for referral to palliative care services.
Acknowledge the distress of the person, their family, and carers. Asking what concerns them most can help identify the priorities of care.
Assist the person and their family and carer(s) to manage dyspnoea so that they feel more in control, can best manage activities, and know what to do in acute episodes of dyspnoea.
Non-pharmacological strategies that can help depending on the context include:
Opioids are the first line pharmacological management for dyspnoea in people with advanced disease or cancer. If they are used, monitor for any side effects such as drowsiness, constipation or nausea, vomiting. The medication may need to be adjusted to find the balance between person’s preferences around drowsiness/alertness and the severity of dyspnoea.
Oxygen therapy may be used if the person is hypoxic and a therapeutic trial indicates that oxygen therapy is beneficial.
Occupational therapists can help with breathlessness through assessment, education, counselling, task redesign and equipment prescription.
Physiotherapists can help with breathlessness through breathing exercises, secretion clearance techniques, pacing and positioning, relaxation techniques, and use of handheld fans.
This information was drawn from the following resources:
Watch Respiratory symptoms in the palliative setting from the Palliative Care Bridge
Read this article by Booth and Johnson (2019)
Access more Dyspnoea resources
Page updated 26 April 2023