Mesothelioma and Shortness of Breath
One of the most distressing symptoms of any type of lung disease is shortness of breath. For people with mesothelioma, this symptom may occur early in the disease process.
Shortness of breath and chest pain are the most common presenting symptoms at diagnosis of malignant pleural mesothelioma (MPM).
According to Dr. Winston Tan, associate professor of medicine with the Mayo Clinic division of hematology/oncology in Florida, at least one of these two symptoms occurs in 60% to 90% of patients.
Fortunately, even after diagnosis and the start of mesothelioma treatment, there are things you can do to breathe easier.
The medical term for shortness of breath is dyspnea. Gaining skills to cope with it is an important part of your mesothelioma care. This can improve your quality of life and help you better tolerate treatment.
What Causes Shortness of Breath in Mesothelioma Patients?
Mesothelioma contributes to shortness of breath in a number of ways, including sensations of pain, poor circulation and loss of lung volume, among other factors.
Pain may limit how deeply a person can breathe. The lungs have very few pain receptors, but the pleura, which is the lining around the lungs, feels pain.
Mesothelioma cancer grows in the pleura. This is why lung cancer often does not cause pain with breathing, but mesothelioma does.
Mesothelioma tumors put pressure on pleural pain receptors. When you breathe, the pleura stretches and moves, contributing to pain around the tumors. Mesothelioma can also invade the ribs and tissues of the chest wall, causing pain.
Peritoneal mesothelioma affects the lining around the abdominal cavity. The peritoneum does not surround the lungs, but it is near them. It is close to the diaphragm, too, an organ important for proper breathing.
Similar to the pleura, the peritoneum can move with each breath. When this movement is restricted by pain, shortness of breath may occur.
Fluid Buildup and Impaired Circulation
Mesothelioma can cause fluid buildup in and around the lungs. This puts pressure on the lungs, so they cannot expand properly. The result is difficulty breathing.
Pericardial mesothelioma affects the lining around the heart. This can lead to abnormal heartbeats, interference with blood circulation and less oxygen reaching the body. Less oxygen can cause shortness of breath.
Restricted Movement, Tissue Stiffness and Loss of Lung Volume
Mesothelioma tumors can restrict normal movement of the lungs, diaphragm, heart and other organs in the chest and abdominal cavities, contributing to breathing problems.
As mesothelioma develops, it can stiffen affected tissues. If lung, diaphragm and heart tissues lose normal flexibility, this also contributes to difficulty catching your breath.
Any abnormal growth in the chest cavity can reduce the space into which the lungs usually expand. When lung volume is limited, breathing becomes more difficult.
Steps to Breathe Easier
Talk to Your Doctor
If your breathing difficulty has a treatable cause, your doctor can help. For example, if fluids are building up around your lungs, your doctor can drain the fluid to ease breathing.
Action items: If you are struggling to breathe, call your doctor for an immediate appointment. If your doctor is not available, head to the nearest urgent care or emergency room.
Keep a record of your symptoms. Share this with your doctor or nurse at every visit. You can identify patterns in how your symptoms are changing or affecting your everyday life.
Check for Infection
If your shortness of breath symptoms change or worsen suddenly, this may signal an infection such as pneumonia.
According to Dr. Stephen C. Schimpff, author of “Fixing the Primary Care Crisis and Longevity Decoded – The 7 Keys to Healthy Aging” and board certified in medical oncology and infectious disease, cancer in and around the lungs may compromise your ability to fight infection.
“If you think you might have pneumonia and have a new fever, cough with more phlegm than usual or pain with breathing, realize this can be quite serious. You should notify your physician as soon as possible,” Schimpff told The Mesothelioma Center at Asbestos.com.
“Do not wait more than a few hours to see if it will clear on its own. Early therapy is critical.”
A Fan Can Help
One inexpensive way to feel better is to use a fan. Researchers have found a personal fan aimed toward the face can help reduce feelings of breathlessness.
According to a 2015 article published in Current Opinion in Supportive and Palliative Care, the hand-held fan should be considered one of the first interventions to try in management plans for patients with chronic breathlessness, even if they have mildly decreased blood oxygen levels.
But a fan cannot replace oxygen. If your blood oxygen levels are significantly lower than normal, a fan will not address the problem. Your doctor can check your oxygen saturation level and prescribe oxygen therapy if needed.
Action Items: Ask a loved one or friend to pick up a few inexpensive, hand-held fans and batteries for each one. Keep one in each room of your house.
Talk to your doctor frequently about symptoms you’re experiencing. You may need oxygen therapy.
Use an Incentive Spirometer
An incentive spirometer is a hand-held device that helps patients improve breathing problems associated with a lung disease or any other condition that affects a person’s breathing.
The patient performs deep breathing exercises with the incentive spirometer, which includes a cylindrical chamber with markings indicating total volume of breath, a piston inside the chamber that moves up and down as you breathe, and a mouthpiece attached to a flexible tube.
Action Item: Ask your doctor if an incentive spirometer will improve your shortness of breath. And if it will, the doctor can order one for you, show you how it works and the number of exercises to perform.
Engage Your Care Team to Function Better
Improving physical function lessens the distress of a mesothelioma diagnosis.
Respiratory therapists and nurses can work with you on gentle exercises and stretches designed to improve breathing and reduce shortness of breath.
A 2017 review paper on caring for mesothelioma patients notes that in order to best manage shortness of breath and other distressing symptoms, excellent palliative care is essential beginning at diagnosis.
Action Item: Ask for a referral to a respiratory therapist or pulmonary nurse specialist to address breathing problems right away.
Make Time for Better Breathing
If you feel rushed, this creates anxiety and stress, which can worsen breathing difficulties.
Action Item: Plan extra time to complete tasks. Use a cellphone or alarm to remind yourself to get ready for appointments 10 to 15 minutes earlier than usual.
Family and friends want to help when a loved one faces a medical challenge.
Action item: When friends ask, “What can I do to help?” take them up on the offer to fix meals, bring in the groceries, make a quick shopping trip for you, bring in the mail, pick up the kids from soccer practice or mow the lawn.
Eat with Breathing in Mind
Feeling overly full can make breathing challenging. More frequent mini-meals and snacks may work better for you than three large meals per day.
Liquids leave the stomach more quickly than solids. High-protein, high-calorie smoothies sipped slowly may be easier on your breathing than a steak and baked potato.
Action items: Keep snacks and high calorie meal replacement shakes on hand. Eat by the clock rather than hunger. Focus on having a few bites or sips at least once an hour throughout the day.
When you lay down on your back, this may worsen breathing. Being flat can significantly increase the effort required to take a breath.
Action items: Experiment with pillows, foam sleeping wedges or other ways to prop yourself up for sleep. Consider sleeping in a recliner chair if one is available. Try sleeping on the opposite side to see if this improves breathing.