Respiratory relief and lung cancer 

In 1878, lung cancer was a rare condition¹—today, it is the leading cause of death worldwide.² most patients find it tiring to seek treatment in total. One life-altering symptom that plagues 70% of all lung cancer patients is dyspnea.³

Dyspnea or breathlessness is a huge cause of problem among lung cancer patients. Anyone would feel alarmed if they suddenly struggled to breathe—after all, air is essential to life. Oncologists struggle with managing dyspnea in cancer patients. Despite this, they recommend respiratory therapy as it relieves symptoms of dyspnea—improving your ability to carry out activities of daily living (ADL).

Understanding lung cancer and its impact on breathing

What is lung cancer?

Your lungs are the most vital respiratory organ in your body. It provides you with a lot of functions

• Gaseous exchange 
• Balancing of PH
• Respiration 
• Sound production
• Protection against foreign particles 

Lung cancer is a fatal condition that develops in the lung tissue and bronchi. It causes uncontrolled cell growth, which reduces the ability of certain functions as mentioned above. Smoking is the main cause of lung cancer.⁴ It is very common among smokers, smoking leads to:

• Dysplasia of the lungs epithelium 
• Genetic mutation 
• Reduction in protein synthesis

Despite this, other factors can cause lung cancer. These factors include:

• Exposure to carcinogens like asbestos and other heavy metals like radon
• Radiation therapy 
• Lung diseases such as pulmonary fibrosis 

How does lung cancer affect your breathing?

Lung cancer causes symptoms that can affect your breathing. These symptoms include:

• Persistent cough causes: 
  • Irritation of the airway 
  • Intensive breathing due to muscle fatigue
• Shortness of breath causes: 
  • Reduction in oxygen levels 
  • Working harder to breathe
  • Muscle fatigue 
  • Chest tightness
  • Hyperventilation to get more oxygen
  • Anxiety because of the feeling of not getting enough oxygen
• Recurring lung infections: lung infections cause inflammation. Some of these infections include:
  • Pneumonia
  • Bronchitis 
  • Common cold 

Repeated inflammation from infections poses a serious risk, potentially leading to pulmonary fibrosis and lung damage. These complications can impair your breathing by causing conditions such as hypoxia and hypoxemia.

• Physical obstruction in the lungs: When tumour cells develop in the bronchi, they can partially cover them. This is dangerous because the bronchi assists the lungs by taking in oxygen and releasing out carbon dioxide. Thus, if tumour cells are present in this area, it can lead to breathlessness

Although the symptoms of lung cancer can cause breathlessness, its treatments can also lead to a problem, the following treatments include chemotherapy and radiotherapy:

• Radiotherapy and chemotherapy can cause lung tissues to change 
• Radiotherapy causes inflammation and side effects like dry cough and shortness of breath
• Chemotherapy causes anaemia as a side effect, which leads to breathlessness

Understanding respiratory relief in lung cancer 

What is respiratory therapy in lung cancer?

Respiratory therapies are techniques or tools that make breathing easier. Although your oncologist may suggest respiratory therapy, they will not administer it—a respiratory therapist will. 

A respiratory therapist works with you and your medical team to relieve issues with your heart and breathing. Depending on the severity, they teach you techniques to help with your symptoms and use tools to aid you if necessary. Their goal is to improve your current symptoms and quality of life.

What are the benefits of respiratory therapy for lung cancer?

The benefits of respiratory therapies depend on the type of therapy your respiratory therapist uses. Despite this, its benefits can be summarised through four points:

• It helps you with symptoms like:
  • Fatigue 
  • Shortness of breath 
  • Anxiety 
• It improves lung functions by clearing the mucus and airways
• It improves your quality of life— giving you more endurance for your daily activities
• It reduces your hospital stay—lowering healthcare expenses

What are the types of respiratory therapies used in lung cancer?

Breathing exercises

There are psychosocial interventions that help with breathlessness. The main purpose of breathing exercises is:

• Correct and reinforce correct breathing patterns 
• Increase breathing with the diaphragm aid 
• Increase alveolar ventilation 
• Prevent fatigue 

Breathing exercises include:

Diaphragmatic breathing

Therapists use diaphragmatic breathing in patients with early stages of lung cancer. They can combine it with other therapies to help with:

• Breathlessness
• Relaxation 
• Stress relief 

This exercise involves breathing with your stomach muscles instead of the upper chest walls. It is effective because it allows the lungs to fill and empty thoroughly with each breath.

Altering breathing rhythms 

This breathing exercise will help you to stay calm and change your breathing pattern from rapid and rushed to calm and regular. To achieve the above benefits, you need to make a conscious effort to control your breathing rhythm. This involves

• Breathing with your nose and mouth
• Inhale with your nose and exhale through your mouth
• You are to hold each breath and release for four seconds
• Pursed lip breathing

This pulmonary rehabilitation exercise also encourages fully exhaled breaths. It involves using your bottom lip to cover your lower teeth and blowing without force—you need to feel the exhaled air on your chin. 

Oxygen therapy

Oxygen therapy is common among those with advanced lung cancer, that is, end-stage lung cancer. It relieves hypoxemia and dyspnea, intending to improve your comfort rather than get a SpO2 reading of 90%. Your therapist places you on oxygen using a delivery device suitable for your state. These delivery devices could be:

• High flow oxygen device:
  • Venturi mask 
  • Reservoir cannulas
  • Nasal cannula 
• Low flow oxygen device:
  • Nasal cannula
  • Simple face mask
  • Non-rebreather mask
  • Transtracheal oxygen catheter 

Inhaled medications 

These drugs can relieve breathlessness, they include:

• Benzodiapenes such as Lorazepam
• Opioids such as Morphine and Fentanyl
• Corticosteroids 

Although they all have limited findings,⁵ respiratory therapists are recommended the following:

• Respiratory therapists should give morphine in low doses. It is the first line of treatment when using drugs for breathlessness
• If the individual is new to morphine, the oncologist should give a starting dose
• Respiratory therapists should give patients opioids laxatives to help with constipation
• Respiratory therapists should not give Benzodiazepines as a first-line therapy due to sedative side effects. They should only give it if opioids do not work and there is anxiety present
• Corticosteroids should be a palliative option to improve the patient's quality of life

FAQs

When should I start respiratory therapy during lung cancer treatment? 

Daily activities can be strenuous, much less when you're breathless. You can perform respiratory therapies at any point during your treatment. Despite this, your treatment will depend on the severity of your condition. Your healthcare provider is best equipped to determine such severity.

Can I do respiratory therapies at home?

Yes, you can do respiratory therapies at home, but it depends on the type of respiratory therapy. You can do breathing exercises and oxygen therapies at home, but you will need a portable oxygen unit for the latter. Regardless, discuss this with your health provider first.

How do I know I need oxygen therapy?

An oncologist prescribes oxygen therapy for you when symptoms of breathlessness are present. Such symptoms include: 

• Inability to catch your breath
• Noisy breathing 
• Very fast and shallow breaths 
• Increased pulse rate 
• Wheezing 
• Chest pain
• Cold and clammy skin
• Anxiety or panic
• Shoulder or upper muscle breathing

Summary 

Your lungs are essential to your everyday life—they help carry out your activities and provide many other vital functions. Hence, lung cancer will cause considerable discomfort when affected. Lung cancer can lead to life-altering and threatening outcomes. Breathlessness occurs due to the symptoms or treatment of lung cancer. Despite this, you can relieve breathlessness through respiratory therapies. Hence, it provides better physical, mental, and emotional well-being. It is important to remember that all respiratory therapies are effective, but contacting your doctor before any treatment is necessary.