Palliative care - shortness of breath

Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses and a possibly limited life span.

Shortness of breath may just be a problem when walking up stairs. Or, it may be so severe that the person has trouble talking or eating.

Shortness of breath has many possible causes, including:

• Anxiety and fear
• Panic attacks
• Lung infections, like pneumonia or bronchitis
• Lung illness, like chronic obstructive pulmonary disease (COPD)
• Problems with the heart, kidneys, or liver
• Anemia
• Constipation

With serious illnesses or at the end of life, it is common to feel short of breath. You may or may not experience it. Talk to your health care team so you know what to expect.

With shortness of breath, you might feel:

• Uncomfortable
• Like you are not getting enough air
• Trouble breathing
• Tired
• Like you are breathing faster
• Fear, anxiety, anger, sadness, or helplessness

You might notice your skin has a bluish tinge on your fingers, toes, nose, ears, or face.

If you feel shortness of breath, even if it is mild, tell someone on your care team. Finding the cause will help the team decide the treatment. The nurse may check how much oxygen is in your blood by connecting your fingertip to a machine called a pulse oximeter. A chest x-ray or an electrocardiogram (ECG) may help your care team find a possible heart or lung problem.

To help with shortness of breath, try:

• Sitting up
• Sitting or sleeping in a reclining chair
• Raising the head of the bed or using pillows to sit up
• Leaning forward

Find ways to relax.

• Listen to calming music.
• Get a massage.
• Put a cool cloth on your neck or head.
• Take slow breaths in through your nose and out through your mouth. It may help to pucker your lips like you were going to whistle. This is called pursed lip breathing.
• Get reassurance from a calm friend, family member, or hospice team member.
• Get a breeze from an open window or a fan.

To breathe easier, understand how to use:

• Oxygen
• Medicines to help with breathing

Any time you are unable to control shortness of breath:

• Contact your health care provider, nurse, or another member of your health care team for advice.
• Call 911 or the local emergency number to get help, if necessary.

Discuss with your provider whether you need to go to the hospital when shortness of breath becomes severe.

Learn more about:

• Advance care directives
• Health care agents

Dyspnea - end-of-life; Hospice care - shortness of breath

Arnold RM, Kutner JS. Palliative care. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 3.

Braithwaite SA, Wessel AL. Dyspnea. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 21.

Chin C, Moffat C, Booth S. Palliative care and symptom control. In: Feather A, Randall D, Waterhouse M, eds. Kumar and Clark's Clinical Medicine. 10th ed. Philadelphia, PA: Elsevier; 2021:chap 7.

Kviatkovsky MJ, Ketterer BN, Goodlin SJ. Palliative care in the cardiac intensive care unit. In: Brown DL, ed. Cardiac Intensive Care. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 52.

Updated by: Frank D. Brodkey, MD, FCCM, Associate Professor, Section of Pulmonary and Critical Care Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.