Breathlessness made easier

Information for patients

Fear and distress caused by shortness of breath can stop you carrying out normal tasks and lead to weakened muscles and deconditioning. Deconditioning is most noticeable in the leg muscles making standing up from a seated position and/or climbing the stairs difficult to do. Often muscles respond well to a daily exercise programme. Activity or exercise, no matter how little or how moderate, is always important. Feeling slightly breathless through exercise is not dangerous and a small amount of regular exercise or activity will make you breathe and feel much better.

It’s important to think about what everyday tasks you can do. Change your routine to help make best use of your energy and place less demand on your breathing.

Using some of these will help you feel more independent and in control:

Planning and pacing your activities

Planning your activities can help you to identify and achieve the things you really want to do.

Think of your breathing capacity as a bank balance, with each activity having its own breathing cost. The aim is to stay in credit, finding a balance between being active whilst not becoming too short of breath or running out of energy.

Pace activities and rest between jobs. Letting others do some daily chores can enable you to do things you find most satisfying or rewarding. You may need to find out by trial and error what you can comfortably do.

The feeling of tiredness or having no energy is something that many people talk about as being especially difficult to cope with. Feeling that you need to rest at several points in the day is perfectly normal, so allow yourself as much rest as you feel you need. It is important to balance periods of rest with some gentle exercise, as prolonged rest can result in a rapid drain of energy, weak muscles and feelings of overwhelming tiredness.

Build up your level of activity slowly. Set yourself small ‘goals’. Aim to accumulate 30 minutes of activity.

Some people have a time of day when they feel particularly tired or breathless. Avoid activity at this time. Enjoy a book, the television or a nap instead.

Walking and managing gentle slopes and stairs

Match the rate of your breathing with your walking pace by breathing in on one step and out on the next two steps. Use this technique while climbing stairs. Breathe in on the first step and out on the next two steps.

Getting this right may take practice. Take your time and match your breathing to the right number of steps, so your breathing is comfortable.

Doing this will help you walk or climb stairs at a steady pace, without having to stop to catch your breath. It may also reduce the time you need to recover once you have reached the top. Many people talk of ‘listening to their body’ or ‘taking things very slowly’ as helpful ways of finding the right pace for them.

Bending

Try to avoid bending over from the waist, it makes breathing difficult and you can become breathless. Instead ease yourself into a crouching position, keeping your back straight and bending from the knees, rather than from the waist.

This allows you to keep your chest upright and your shoulders back, to help you continue to breathe as comfortably as possible.

As you ease yourself into this position ensure you have something secure to hold onto such as a table or chair. This will provide extra support and give you something to push against as you stand up.

Also having something to lean back against once in that position is helpful.

If you need to work at a level below your waist, emptying the washing machine or a cupboard, or gardening, use a low stool and sit, rather than bend.

Lifting heavy items

Lifting heavy items such as wet laundry or shopping bags can cause you to become tired or short of breath quickly. Try placing the washing on a stool next to the clothesline.

Do not carry bags with your arms by your sides, as the effect of heavy bags dragging your arms down restricts breathing and you can become breathless. Use a wheeled shopping trolley instead, ask family or friends to help, or use home delivery.

Arranging things around the house

Put items used most frequently in easily accessible places. Use wall cupboards, rather than low cupboards or drawers, to avoid bending for them. Also ensure you do not have to stretch for items. This may take some organisation, but will help make life easier.

Dressing

Sit for as much time as possible while dressing and use abdominal or tummy breathing throughout.

Try to wear loose fitting clothes especially around the waist and chest. Avoid bending over to put on socks, tights, shoes etc.

Talking on the phone

Rushing to answer the phone before someone hangs up or standing to talk can make your breathlessness more noticeable. Try to make sure that family, friends or work colleagues know that it can take time to answer the phone. Ask them to let the phone ring for longer so you don’t have to rush to it. Make sure you are sitting down comfortably before picking up the phone and take a moment to ‘catch your breath’ before starting your conversation.

If you find you become breathless while talking on the phone or in conversation, talk slowly, use short sentences and pause after each sentence to take a relaxed breath.

Showering and bathing

Showering, bathing and dressing can be exhausting and bathrooms can feel claustrophobic which will increase the feeling of breathlessness. When the weather allows, opening a window slightly may help to reduce shortness of breath.

Tips that help to make bathing or taking a shower easier:

1. As you undress resist the temptation of holding your breath as you pull clothes over your Take your arms out first, then quickly slip it over your head. So your face is covered as little as possible and you don’t have to raise your arms for long.
2. Not filling the bath too full and not having the water too hot.
3. Once you are undressed, sit at the side of the bath and slowly lift one leg in at a time rather than swinging both legs in together.
4. Ask an Occupational Therapist (OT) for advice about aids that would make things easier for you.
5. Use the breathing exercises before lowering yourself into the Sitting in the shower may be less tiring.
6. Position the shower to avoid water spraying directly onto your face.
7. Let the water out of the bath before you get You may find it easier to lift yourself onto your knees first and rest before you stand.
8. While you sit at the side of the bath wrap a large towel around yourself so that you begin to This reduces the effort of patting yourself dry. A towelling dressing gown can do the drying for you instead.
9. Sit when you dry yourself, bring your feet up to prevent bending over to dry your feet and legs.
10. Rest as frequently as you need.

And remember to use lower chest breathing.

Gardening

Being breathless can make gardening difficult. Problems range from continually bending down, to not being able to get up after sitting to plant bulbs or to weed. A low garden chair placed alongside borders or flowerbeds may help you to weed or prune without having to bend over, and make it more comfortable.

Rest if you feel you need to.

If these positions aren’t helpful, plant flowers in pots or trays positioned at waist level when working with them.

Do a little at a time so that you don’t become exhausted.

Remember to use tummy breathing during activities such as gardening. You will find that you can do more before becoming breathless.

Eating

A healthy diet helps to keep you feeling well, although this may seem hard to believe when you have lost your appetite.

It can be frustrating and upsetting when you cannot eat a favourite meal or snack, or join family or friends for meals. Talking and finding ways to overcome the difficulties can help with you and your family’s concerns.

Taste changes can play a part in reducing appetite.

These tips may help:

If food tastes bitter

• Eat white meat, fish, eggs, milk and cheese instead of red meat, tomatoes and chocolate
• Try sweet flavoured drinks, fizzy drinks and ice-lollies – these may be more palatable than tea, coffee or sour juices
• Add herbs and spices to your meals as these can help to conceal bitter tastes

If food tastes too sweet

• Cook with sour juices, herbs, vinegar, spices or mint

If food has no taste at all try

• Adding lots of seasoning and sugar to meals and eating food at room temperature

Mealtimes – remember little and often!

• Small helpings of enjoyable meals or snacks may helps you get more pleasure from food and result in you eating more than attempting large meals
• Sipping a small glass of sherry before food can help stimulate appetite
• Pain can suppress appetite. If you have pain take painkillers regularly. If you have occasional pain a tablet half an hour before eating can help reduce its impact on your appetite
• If being breathless makes eating difficult, eating slowly and taking small mouthfuls of food makes it easier to chew and swallow
• Include plenty of fluid in your diet. Avoid fluids that have low calories, for example juice, tea or These will fill you up without adding to your energy intake
• High calorie and protein supplements can be added to food and drink, or drunk on their own, and are a good way of boosting energy intake
• Some supplements are available on prescription g. Fortsip, Maxijul or Ensure. Others can be bought over the counter in most chemists e.g. Complan or Build-up
• If they are too sweet or bland supplements can be mixed with other ingredients. Try mixing a sachet with a pint of full-fat milk and a portion of ice Whisk together and keep in the fridge. This will keep for up to 24 hours. Sip two or three glasses a day. Ice cubes are an alternative: if ice cream is too sweet; try mixing a sachet with a tin of soup or in stew, add a spoonful of cream just before you serve
• Drink them hot or cold, rather than at room temperature
• Avoid drinking too much fluid before you eat a meal as this will reduce your appetite
• If you enjoy full fat milk, chocolate, cheese or butter have some! Although you sit and rest more than usual, your body is working to full capacity fighting your illness, responding to treatments and medications, and the extra calories will come in useful
• Include plenty of fruit and vegetables in your diet. Combine them with protein supplements mentioned above or they can be eaten with cream, butter etc.