Eldercare at Home: Breathing Problems
Caregiving How Tos
Understanding the Problem
As people age, certain activities, such as going up a flight of stairs, can make them slightly winded or out of breath. This may be because they are out of condition due to physical inactivity. However, aging sometimes brings on other more serious breathing problems including incapacitating shortness of breath, chest discomfort, wheezing, and coughing. While these symptoms are common, they should not be considered a normal part of aging.
Breathing difficulty is usually a result of a medical problem or condition, no matter how old you are.
Medical conditions that can cause breathing problems include chronic obstructive pulmonary disease (known as COPD which includes pulmonary emphysema, chronic bronchitis, and asthma), pneumonia, heart failure, neurological disorders (such as stroke), and cancer. Breathing problems are also sometimes linked to anemia, allergies, colds, sinus problems, and heartburn. People who are overweight are more prone to breathing problems.
As a caregiver, your job is to be alert to changes in the older person's breathing and to make sure the changes are reported to the doctor. You should also make certain that a treatment routine is followed and that all medicines are used properly. Encourage the older person to quit smoking, get needed immunizations, and exercise regularly to prevent or reduce breathing problems.
Your goals are to:
- Help prevent breathing problems from happening
- Report breathing problems to the doctor
- Insure that directions for treatment are followed
Call the doctor or nurse immediately or go to the emergency room if any of the following symptoms occur:
- Sudden onset of severe shortness of breath. This could be a flare-up of chronic lung disease like COPD, or it might mean an infection such as pneumonia or acute bronchitis or the onset of heart failure.
- Sudden chest pain. Often sudden chest pain can indicate a heart problem, but it can also signal a lung problem, such as a collapsed lung or blood clot in the lung.
- A fever of 100 degrees F (37.8 degrees C) or higher with or without a cough. Fever could mean a serious infection such as pneumonia. Pneumonia is often accompanied by chest pain and cough. High fevers put an added strain on the heart and circulation and thus cause more problems.
Call the doctor or nurse during office hours to discuss the following problems:
- Increased shortness of breath during activity. This may indicate heart or lung problems.
- Persistent cough. Especially if there is an increase in the amount or change in the color of the sputum (phlegm).
- A cough that brings up blood. Even small amounts of blood should be reported to the doctor. Smokers who have bronchitis often have this condition, but it could signal cancer or other problems.
- Changes in breathing during sleep. Loud snoring and choking sounds, or long periods of time (15-60 seconds) without a breath, may be signs of sleep apnea, a disorder in which breathing stops during sleep. It is most common in elderly, overweight men with a thick neck or jowls. See the "Sleep Problems" chapter for a more detailed discussion.
- Swallowing problems. These can cause breathing problems, for example, if solid food or liquids get misdirected into the trachea (windpipe). Often this is associated with a cough that occurs during eating or drinking and can result in lung inflammation or even pneumonia. "Heartburn" is a feeling of acidity occurring anywhere from the upper stomach area to underneath the breastbone to the throat. This may happen after eating certain foods or while lying down or sleeping and may make breathing problems, especially asthma, worse.
Know the answers to the following questions before calling the doctor:
- What is the older person's temperature? (For accurate readings, place the thermometer underneath the tongue with the lips closed for five minutes.)
- Have there been any shaking chills or excessive sweating?
- What is the person's pulse? Is it regular or does it skip? To check the pulse, face the person's palm down and notice where the bone juts out just below the wrist. With two fingers feel the palm side of the wrist in line with the bone that juts out. Move your fingers until you can sense the pulse. Count the number of pulses for a minute. That is the person's pulse rate.
- Is he or she coughing and is anything coming up? What does the phlegm (or sputum) look like (yellow, green, clear)? Is any blood coming up? Have the older person spit into a tissue and then examine what is there.
- Where is the chest pain and how is it described? Is it dull? Sharp? Sticking? Squeezing? Is it continuous (persistent) or intermittent ?
- Does a deep breath make the symptoms (especially chest pain) worse or does it make them better?
- When was the older person's most recent chest x-ray and what did it show?
- Does he or she smoke? How much?
- What lung problems has the older person had in the past?
- Does he or she have any allergies?
- What medications is the older person taking?
Here is an example of what you might say when calling:
"This is Maryann Smith, Joseph Smith's wife. Joe is having severe shortness of breath along with pain over his right chest below his armpit. It began suddenly and is continuous. He says it's sharp and feels like a vise. Breathing seems to make the symptoms more severe. He doesn't have a cough and his temperature is normal. The only medicine he is taking now is for his high blood pressure. What should I do?"
Help control symptoms of patients with chronic lung problems (pulmonary emphysema, chronic bronchitis, or asthma)
- Encourage drinking fluids.
People with COPD (chronic obstructive pulmonary disease) should drink plenty of non-alcoholic fluids. Drinking water or juices helps to bring up mucous from the lungs and clear them out.
- Be aware that lung infections (chest colds) are an especially serious cause of complications for COPD patients and must be taken seriously.
- Avoid over-the- Counter cough medicines unless recommended by your doctor.
Over-the-counter (nonprescription) cough medicines tend to dry the lungs out and are not recommended. When people with COPD become dried out, their secretions become thicker (like glue) and can plug up their airways and make symptoms worse.
- Insure that prescribed medicines are used correctly.
People who have COPD are often given prescriptions for inhaled bronchodilators, which are medicines in small aerosol or spray cans. The inhaled bronchodilators open up air passages by relaxing them, reducing the swollen linings of airways, and decreasing mucous production. To get all the benefits of a bronchodilator, it must be used as directed.
- Suggestions on how to help with using inhaled bronchodilators include the following:
- Ask the doctor or nurse to give you and the older person a demonstration on how to use the spray correctly. Also have them show you how to tell when the medicine in the inhaler is running out, by floating the canister in water.
- Ask about devices that make it easier to operate the spray. Older people may have difficulty aiming the spray into the mouth. "Spacers" which are hollow tubes that go between the spray can and the mouth are helpful if coordination is a problem.
- Operate the spray yourself.. If the older person cannot use the spray correctly, you can operate the spray and coordinate it with his or her breathing; however, you should have instruction from a health professional before you do this.
- Seek other methods. If the inhaled bronchodilator is not working out, tell the doctor. There are other ways of taking the needed drugs, such as inhaling a mist produced by a machine with a small motor. However, these methods are often more cumbersome and expensive than the spray canister bronchodilator.
- Check the expiration date on inhalers. Some medicines in inhalers are used only when needed and not everyday. If so, they can get old and out of date very easily. Do not use out-of-date inhalers.
- Monitor and assist in the use of oxygen.
Oxygen therapy is sometimes prescribed for breathing problems. Treatment can be taken at home. The oxygen comes from a large cylinder or an electrically powered oxygen concentrater which is delivered to the home by a respiratory therapist. The therapist should instruct you and the older person on how to use the oxygen equipment, when to use it (for example, all the time, while sleeping, or while exercising) and whom to call if there is a problem. The doctor orders the amount and checks the older person's oxygen levels usually every six months (or more often if needed) to see if the amount of oxygen needs to be changed. DO NOT GIVE MORE OXYGEN than ordered.
- Be sure that all of prescribed medicines are taken.
Don't stop giving a medicine because symptoms have disappeared and the person is feeling better. Prescribed medicines for breathing should be taken until completion to prevent a relapse. Contact your doctor's office before stopping or running out of a medicine.
Prevent problems from occurring
- Follow a regular exercise program.
It is a myth that people with breathing problems need to "take it easy" and not exert themselves. In general, people with lung problems should be more active, not less. Exercise programs can improve breathing efficiency as well as general physical conditioning, which can lead to a better quality of life. Exercise should not follow a large meal or be undertaken in extreme heat or during periods of high humidity or air pollution. Precautions should be taken to reduce the risk of falls, and people who already have shortness of breath should check with their doctor before starting an exercise program. The doctor may refer the older person to a rehabilitation program for patients who have COPD and heart disease. Such programs are often covered by Medicare and other health insurance plans.
- Encourage walking.
Walking is good exercise and can be done almost anywhere: the halls of an apartment building, a shopping mall, outdoors, or around the house. Hospitals, clinics, and YMCAs may offer local walking programs in other spaces.
- Help smokers quit smoking.
"It's never too late to quit" is true no matter how long a person has been a smoker. Even people who quit late in life will have increased health benefits including reduced risk of cancer, lung disease, and stroke. Coughing and shortness of breath will usually decrease within a few weeks. Help is available for people who want to quit smoking. Here are some resources:
- The older person's doctor.
Doctors can provide counseling, motivation, medications, and can recommend programs that have helped other patients.
- Stop-smoking programs.
Many hospitals and medical centers offer stop-smoking programs - often free. Call around and see what is offered in your area. If the older person is unable to attend, consider attending yourself. You may be able to pick up useful information and advice that you can bring back and share.
- The American Lung Association
Your local chapter will provide materials including home video and audiotape programs, self-help guides for smokers, and guides for non-smokers to support those trying to quit. Ask for the publication "Helping Smokers Get Ready to Quit". The American Lung Association also can also refer you to local classes to help people quit smoking.
- The American Heart Association and American Cancer Society are also excellent sources of information on diet, exercise and breathing problems. They also offer stop smoking programs across the country.
- Stop smoking yourself.
Set an example for the older person if you are a smoker. If you aren't ready to quit, at least don't smoke in front of the older person.
- Encourage regular sleep.
People with sleep apnea or problems with breathing during sleep can experience fewer or less severe breathing symptoms by following a regular nighttime routine. For example, avoid eating or drinking coffee or alcohol immediately before going to bed. If unable to fall asleep, get out of bed and read or watch TV until you are sleepy. For more information, visit Sleep Problems.
- Avoid sleeping pills.
All people with lung problems should avoid sedatives (sleeping pills including those that are available with a prescription) which slow breathing.
- Discourage alcohol.
Alcohol increases the volume of secretions in the lungs which can make breathing problems worse. It also make sleep apnea and other sleeping problems worse.
- Make sure immunizations are up to date.
All people 55 years and older, and anyone with lung problems, - should get annual influenza vaccinations and pneumococcal vaccine at least once and perhaps every 7-10 years.
- Maintain good nutrition to avoid weight loss ( unless you are obese).
Since a poor nutritional state is associated with lowered resistance.
What To Do About Breathing Problems During Sexual Activity
Shortness of breath during sex can be managed by following a few basic principles:
- Mild shortness of breath is not a cause for concern.
- The pace should be determined by the partner with the breathing problem. These issues should be discussed frankly between the partners and between the partners and their physician.
- Try new, less strenuous positions, ask your doctor or a physical therapist.
- Oxygen during sex is often beneficial in reducing breathing symptoms. The need for oxygen can be determined by exercise testing.
Problems You Might Have Carrying Out Your Plan
"Of course I have trouble breathing. I'm old."
Normal aging does not cause breathing problems. Lungs may slow down a bit, but for normal activity - climbing stairs, carrying the groceries - breathing should not limit what a person can do. Wheezing, coughing, shortness of breath are not normal at any age.
"I'm too frail to exercise."
Frailty leads to more frailty. Exercise can help strengthen and condition the lungs, circulation, and entire body. Exercise does not have to be vigorous. Even frail people can exercise safely, such as exercising in a swimming pool or while sitting or lying down. Get advice from your doctor, who can refer you to programs in your community, and give you specific advice on how to start.
"It's too late for me to stop smoking."
Medical studies show it is never too late. Some of the benefits of quitting smoking for older people include reduced risk of cancer and lung disease, healthier heart and lungs, improved blood circulation, and less coughing and shortness of breath.
Think of Other Problems You Might Have Carrying Out Your Plan
What other problems could get in the way of doing the things suggested in this section? For example, will the older person cooperate? Will other people help? How will you explain your needs to other people? Do you have the time and energy to carry out this plan?
Do not expect to see positive results immediately. Improving breathing problems is a long-term project. It usually takes three to six months to see a noticeable improvement. The doctor or nurse will be able to assess improvement by measuring breathing capacity. Family members can check on improvement by noticing if breathing is easier, if smoking has decreased, if appetite is better, if fatigue is less, and if exercise has increased.
Review your plan with a home health nurse. They are often knowledgeable about developing and monitoring wellness programs.
What to Do If Your Plan Isn't Working
If your plan doesn't seem to be working, ask yourself if you are expecting change too fast. It usually takes time for the body to respond to treatment.
If breathing problems are increasing, ask the doctor or nurse for help. Tell them what you have done and what the results have been.