Managing Breathlessness at the End of Life

Join SevenPonds each month as Tani Bahti, RN, CT, CHPN, offers practical on-hand guidance to demystify the dying process. As an RN since 1976, Tani has been working to empower families and healthcare professionals to have the best end-of-life experience possible both through education and the development of helpful tools and resources. As the current Director of Pathways, Tani is also the author of “Dying to Know, Straight talk about Death and Dying,” considered by SevenPonds as one of the most practical books on the topic. Founder Suzette Sherman says this is “the book I will have at the bedside of my dying parents some day, hopefully a very long time from now.”

“Is my husband going to suffocate in the end?”

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That’s a fearfully whispered question I often hear when a person has terminal lung disease.

What can be scarier than not being able to catch your breath or watching your loved one struggle to breathe?

People with lung disease may have experienced increasing difficulty in breathing over months or years, if not managed by a knowledgeable healthcare provider. I can understand why these folks fear they will be gasping for air near the end. That’s why a hospice and palliative care team is highly recommended, not only to improve comfort and function, but to help people understand how the body will ultimately shut down and die. By addressing this early on, fear can be diminished and the knowledge and tools to manage shortness of breath can be empowering by promoting quality of life.

What can be scarier than not being able to catch your breath or watching your loved one struggle to breathe?

Let me give you some good news.

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Breathlessness can be managed primarily with medications and oxygen. Often a combination of morphine and something for anxiety helps to cut down the workload on the heart, relax airways and decrease the anxiety that can contribute to further shortness of breath. No, the morphine does not hasten death. It does provide the comfort and control people seek.

I’ve had patients whose breathing previously was poorly controlled, causing them to be bed bound or home bound. Once they understood how to properly use their morphine, they were then able to go shopping or visit friends. That’s enhancing quality of life.

Sometimes breathing patterns change as death approaches, and the family is worried this means the person is struggling for air.

In addition to medication, elevating the head rather than lying flat helps with lung expansion.

Using a small fan pointed at an angle to the face can stimulate the trigeminal nerve, which helps with relaxing and breathing.

Healing touch and reiki techniques have also been useful. Find what works best for you.

Sometimes breathing patterns change as death approaches, and the family is worried this means the person is struggling for air. The rapid, slow or irregular breathing that can occur is the result of changes in the body related to the particular disease. These changes in breathing patterns are not signs of discomfort or struggle.

Increasing oxygen at this time not only does not promote more comfort, but in fact is contrary to the body’s natural processes and can prolong the dying experience.

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When a person with lung disease is actively dying, his oxygen level naturally goes down. When it gets low enough, the person goes into a coma. He ‘goes to sleep’ while the body continues to shut down. That’s the wisdom and blessing of body. Increasing oxygen at this time not only does not promote more comfort, but in fact is contrary to the body’s natural processes and can prolong the dying experience.

So be sure you have a good hospice team that will provide the guidance, education, medications and techniques to manage breathing. That will diminish your fears while helping you be in more control.

That way, everyone can breathe easier.

Take a look at a copy of Tani’s book “Dying to Know, Straight talk about Death and Dying” to help demystify the process and offer words of wisdom on the many aspects of dying.