Introduction to living with breathlessness

Breathlessness is a common symptom for people living with a life limiting illness. It can be distressing for the individual, as well as their family members and carers, but there are lots of things you can do to help manage it.

Breathlessness is difficult, laboured breathing that can make people feel uncomfortably aware of their breathing. It is a complex symptom involving physical, psychological, environmental and functional factors. 

Breathlessness can be severe and short in duration, or it can be ongoing and gradually increase in severity. It can be continuous or it can come and go.

There is more information and links to videos below.

Anatomy

Your diaphragm

The main muscle of breathing is the diaphragm. This is a large flat sheet of muscle covering the base of your ribs. It moves down to help draw air into your lungs and as you breathe out it relaxes, moving upwards.

Your Accessory Muscles

Some of the muscle around your shoulders and neck can further help to draw air into your lungs when you become breathless. These are known as accessory muscles.

It is normal to use these muscles for short periods of time when very breathless, however they are not designed to help with breathing for long periods. Overuse can make them become stiff painful.

Positions that help your breathing

When short of breath you may find it helpful to get into a comfortable position with your arms supported.  These positions help your diaphragm to expand and encourage your accessory muscles to relax.

When using these positions try to keep your back straight but let your head drop so that your neck is relaxed. Also try to relax your shoulders and arms including your wrists.

Techniques that help your breathing

Breathing Control

Breathlessness can make you breathe with your upper chest and shoulder muscles, rather than your diaphragm and lower chest. This causes fast and shallow breathing, which uses more energy and makes you tired. Breathing control is the most efficient way of breathing. It helps you to only take in the air that you need and to avoid unnecessary effort.  It will help you when you are short of breath or feeling anxious, but it is good to practise this at a time when you are sitting, relaxed and not feeling breathless.

Get into a comfortable position, with your arms supported on arm rests or your lap. It is really important that your shoulders and body are relaxed and as loose as possible. You may also find it helpful to place a small cushion in the small of your back.

  • Place one hand on your chest and the other on your stomach.
  • Close your eyes to help you relax and focus on your breathing.
  • Slowly breathe in through your nose, with your mouth closed. You should be able to feel your stomach move out against your hand. If your breathing is controlled, the hand on your chest will hardly move.
  • Breathe out through your nose. Your stomach will fall gently.
  • Try to use as little effort as possible and make your breaths slow, relaxed and smooth. With every breath out, try to feel more relaxed. Gradually try to breathe more slowly.

When fully in control of your breathing, your out breath should take longer than your in breath. There should be a natural pause at the end of your out breath.

Watch our videos Living with breathlessness here:

Breathe a Rectangle

When practising breathing control it can help to imagine or look at a rectangle. Wherever you are, there is often a rectangle to be seen, for example a TV, picture, book, door or window. 

Follow the sides of this rectangle with your eyes as you breathe. Gradually slow the speed at which your eyes move around the edge of the rectangle to slow your breathing.

Pursed Lip Breathing

Pursed lip breathing is a technique that can help people when they experience shortness of breath by providing a quick and easy way to slow your pace of breathing and make each breath more effective. The technique helps to keep airways open longer so that you can remove the air that is trapped in your lungs.

To practise pursed lip breathing

  • Sit down in a chair and relax your neck and shoulder muscles.
  • Breathe in slowly through your nose, then " Pucker, or "purse" your lips as if you were going to whistle or gently blow out a candle.
  • Breathe out all of the air in your lungs through your mouth slowly and gently through pursed lips.

Try to breathe out for longer than your inhale, but only for as long as is comfortable – don’t force your lungs to empty.

Blow As You Go

Blow-as-you-go helps make tasks and activities easier. It is a useful technique to help when doing anything physical which makes you breathless.

  • Breathe in before you make the effort
  • Exhale while you’re making the effort. You can also breathe out using pursed lips if this helps.

For example, when standing up, breathe in before you step or stand up, and then blow out as you stand up. Or when lifting a heavy bag, breathe in before you lift the bag and then breathe out as you lift the bag.

Anxiety Related to Breathlessness

Breathlessness is closely linked to anxiety. Anxiety is an emotional response to breathlessness, but it can also make breathlessness worse.   See the page on managing anxiety by clicking here.

Watch our video on Living with anxiety here:

The spiral of inactivity

Sometimes, because feeling breathless is unpleasant and makes you feel anxious you may avoid activities that you know will make you feel out of breath. 

If you avoid these activities, your muscles become weaker. Weaker muscles need more oxygen to work and so over time you will become more breathless. This is called the cycle of inactivity.

It is possible to break this cycle of inactivity. By becoming more active you can make your muscles stronger, including your breathing muscles. This will help you feel less out of breath when you do everyday tasks.

Go to the page on physical activity