Management of Symptoms of Dyspnea

by National Cancer Institute

(Page 2 of 5)

Management of the symptoms of dyspnea may include the following:

Oxygen therapy

Patients who cannot breathe enough oxygen from the air may be given supplemental oxygen to inhale from tanks or cylinders. Devices that concentrate oxygen already in the air may also be prescribed.

Medicines

Pain medicines may reduce physical and mental distress and exhaustion, and improve the patient's quality of life. Other drugs may be used to treat dyspnea that is related to panic disorder or severe anxiety.

Support and counseling

Supportive measures may be effective for some patients. These measures include the following:

• New breathing techniques.
• Cold air directed across the cheek.
• Meditation.
• Relaxation training.
• Biofeedback.
• Psychotherapy.

Management of Chronic Cough

In some patients, chronic (long-term) coughing causes pain, interferes with sleep, and worsens dyspnea and fatigue. Treatments include the following:

• Cough-suppressing medicine.
• Medicines that break down mucus.
• An inhaled drug for chronic coughing related to lung cancer.

Malignant Pleural Effusions

General Information about Malignant Pleural Effusions

The pleural cavity is the space surrounding each lung in the chest. The pleura is the thin layer of tissue that covers the outer surface of each lung and lines the interior wall of the chest cavity, creating a sac that encloses the pleural cavity. Pleural tissue normally produces a small amount of fluid that helps the lungs move smoothly in the chest while a person is breathing. A pleural effusion is an increased amount of fluid in the pleural cavity, which then presses on the lungs and makes breathing difficult.

Causes of Malignant Pleural Effusions

Pleural effusions may be malignant (caused by cancer) or nonmalignant (caused by a condition that is not cancer). Malignant effusions are a common complication of cancer. Lung cancer, breast cancer, lymphoma, and leukemia cause most malignant effusions. Effusions caused by cancer treatment, such as radiation therapy or chemotherapy, are called paramalignant effusions.

Not all pleural effusions found in cancer patients are malignant. Cancer patients often develop conditions such as congestive heart failure, pneumonia, pulmonary embolism, and malnutrition, and these conditions may cause pleural effusions to occur.

Diagnosis of Malignant Pleural Effusion

The following symptoms may be caused by malignant pleural effusion:

• Dyspnea.
• Cough.
• Chest pain.

The management of a malignant pleural effusion is different from the management of a nonmalignant effusion, so an accurate diagnosis is important. Diagnostic tests may include the following:

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

CT scan: A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

Thoracentesis: The removal of fluid from the pleural cavity using a needle inserted between the ribs. This procedure may be used to reduce pressure on the lungs and/or to check the fluid under a microscope to see if cancer cells are present.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. If thoracentesis is not possible, a biopsy may be done during a thoracoscopy, a surgical procedure to look at the organs inside the chest to check for abnormal areas. An incision (cut) is made between two ribs and a thoracoscope (a thin, lighted tube) is inserted into the chest. Samples are then taken for biopsy.

Managing Malignant Pleural Effusions

Malignant pleural effusions often occur in advanced or unresectable cancer or in the last few weeks of life. The goal of treatment is usually palliative, to relieve the symptoms and improve the quality of life. The goals of therapy will depend on a number of factors, including the following:

• The prognosis (chance of recovery).
• The patient's preferences in regard to the risks and benefits of treatment.
• The patient's ability to perform activities of daily living.
• The type of primary cancer.
• The number and type of previous treatments. For example, patients whose cancer has not responded to chemotherapy are unlikely to obtain symptom relief with additional chemotherapy.

Treatment of the symptoms of malignant pleural effusion may include the following:

Thoracentesis

Removal of fluid from the pleural cavity using a needle may help to alleviate severe symptoms in the short-term. A few days after thoracentesis, the effusion will begin to reform. Repeated thoracentesis has risks, however, including bleeding, infection, collapsed lung, fluid in the lungs, and low blood pressure.

Pleurodesis

This is a procedure to close the pleural sac so that fluid cannot collect there. Fluid is first removed by thoracentesis. A drug or chemical that causes the sac to close is then inserted into the space through a chest tube. Chemical agents such as bleomycin or talc may be used.

Surgery

Surgery may be done to implant a shunt (tube) to transfer the fluid from the pleural cavity to the peritoneal (abdominal) cavity, where the fluid can be more easily removed. Another option is pleurectomy, removal of the part of the pleura that lines the chest.

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