Caregiver Guide: Breathing Problems

Understanding the Problem

As people age, certain activities can make them slightly winded or out of breath.  (These may be activities like going up a flight of stairs.)  This simply may be related to being out of condition due to physical inactivity.

However, aging sometimes brings on other, more serious, breathing problems.  This includes chest discomfort, wheezing, coughing, and/or shortness of breath that makes it difficult to perform normal activities. While these symptoms can be common, they should not be considered a normal part of aging.

Difficulty breathing is usually a result of a medical problem or condition, no matter how old you are.

There are some medical conditions that can cause breathing problems. Some of these include pneumonia, heart failure, neurologic disorders (such as stroke), cancer, and include chronic obstructive pulmonary disease (known as COPD).  COPD includes pulmonary emphysema, chronic bronchitis, and asthma.

Breathing problems are also sometimes linked to anemia, allergies, colds, sinus problems, and heartburn. People who are overweight are also 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 healthcare provider. 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:

  • Prevent breathing problems from happening
  • Report breathing problems to the healthcare provider
  • Make sure that directions for treatment are followed

Click on each of the topics below to read more.

When to Get Professional Help

Call a healthcare provider 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 like pneumonia or acute bronchitis.  It could even be heart failure. 

Sudden chest pain

Often sudden chest pain can indicate a heart problem.  It can also signal a lung problem, such as a collapsed lung or a 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 can cause more problems.

Call the healthcare provider 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 more phlegm or a change in the phlegm’s color.

A cough that brings up blood

A cough that brings up even small amounts of blood should be reported to the healthcare provider. Smokers who have bronchitis often have this condition.  But it could also be a sign of cancer or other problems.

Changes in breathing during sleep

Watch out for signs of breathing problems during sleep, such as loud snoring and choking sounds or long periods of time (15-60 seconds) without a breath. These may be signs of sleep apnea, a disorder in which breathing stops during sleep. It is most common in older, overweight men with a thick neck or jowls (loose skin at the bottom of the face and cheeks). (See “Sleep Problems” for a more detailed discussion.) 

Swallowing problems

​​​​​​​​​​​​​​Swallowing problems can cause breathing problems.  For example, solid food or liquids can enter into the trachea (windpipe) instead of going down the throat. Often this is associated with a cough that occurs while eating or drinking. This condition can result in lung inflammation or even pneumonia. “Heartburn” is when someone feels acid or a burning feeling occurring anywhere between the upper stomach area and the throat. This may happen after eating certain foods or while lying down or sleeping.  Heartburn can make breathing problems, especially asthma, worse.  

Know the answers to the following questions before calling the healthcare provider

  • What is the older person's temperature? (For accurate readings, place the thermometer underneath the tongue with the lips closed for five minutes.) 
  • Have they been having any shaking chills or excessive sweating?
  • What is the person’s pulse? Is it regular or does it skip? To check the pulse, move the person’s hand so the palm faces up.  Find where the bone sticks outward, just below the wrist. With two fingers, feel the palm side of the wrist lined up with the bone that sticks out. Move your fingers until you can feel the pulse.  Count the number of pulses for 60 seconds. That is the person’s pulse rate.
  • Is the older person coughing and is anything coming up? What does the phlegm look like (yellow, green, clear)? Is any blood coming up? Ask the older person to spit into a tissue and then examine what it looks like.
  • Is the older person having chest pain?  Where is it?  How is it described? Is it dull? Sharp? Sticking? Squeezing? Is the pain non-stop (persistent) or does it start and stop (intermittent)?
  • On a scale of 1 to 10, how does the older adult rate the pain, if 10 is the worst pain?
  • Does taking 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? What did it show?
  • Does the older person smoke? How much?
  • Is there wheezing when the older person breathes? 
  • What lung problems has the older person had in the past? 
  • Is there a family history of lung problems?
  • Does the older person have any allergies?
  • What medicines is the older person taking?

What You Can Do to Help

Help control symptoms of patients with chronic lung problems (pulmonary emphysema, chronic bronchitis, or asthma)

Encourage drinking fluids

People with lung problems like COPD (chronic obstructive pulmonary disease) should drink plenty of non-alcoholic fluids. Drinking water or juices helps to bring up phlegm and mucus from the lungs and clear them out. 

Be aware of lung infections (chest colds)

They are an especially serious cause of complications for COPD patients and must be taken seriously. They can cause serious complications and even send someone to the hospital.

Avoid over-the-counter cough medicines unless recommended by the healthcare provider

These medicines tend to dry the lungs out and are not recommended. When people with COPD become dried out, their secretions can become thick like glue.  This can plug up their airways and make symptoms worse. 

Be sure that prescribed medicines are used correctly

People who have COPD are often given prescriptions for inhaled bronchodilators.  These are medicines in small aerosol or spray cans. The inhaled bronchodilators open up air passages by relaxing them.  This reduces the swollen linings of airways, and decrease mucus production. To get all the benefits of a bronchodilator, it must be used as directed.

Ask the healthcare provider to show how to use bronchodilators correctly

Also have them show you how to tell when the medicine in the inhaler is running out.  This is usually done by placing the container in water and seeing if it sinks or floats.  If the container sinks, it still has medicine.  If it floats, the container is almost out of medicine. 

Ask about devices that make it easier to operate the bronchodilator’s spray

Older people may have trouble operating an aerosol canister because they don't have the coordination to work the spray. “Spacers” are hollow tubes that go between the spray can and the mouth.  These can be are helpful if coordination is a problem.

Learn how to help the older person inhale the spray

If the older person cannot use the spray correctly, you can operate the spray.  Make sure to coordinate it with the breath.  The medicine should be sprayed when the older adult is breathing in. You should always make sure that you have a healthcare provider show you how to do this before you try it.

Ask the healthcare provider about other ways to take breathing medicines 

If using an inhaled bronchodilator is not working out for the older person, tell the healthcare provider. 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 difficult to use and more expensive than the spray canister bronchodilator.

Check the expiration date on bronchodilators

Some medicines in inhalers are used only when they are needed, and not every day. If so, they can get old and out-of-date very easily. Do not use expired or out-of-date inhalers.

Learn how to monitor and assist in the use of oxygen 

Oxygen therapy is sometimes prescribed for breathing problems. Treatment can be given at home.  The oxygen comes from a large cylinder or an electrically powered oxygen concentrator.  It is delivered to the home by a respiratory therapist. The therapist should instruct you and the older person on the following things:

  • how to use the oxygen equipment
  • when to use it (for example, all the time, while sleeping, or while exercising) 
  • whom to call if there is a problem
The healthcare provider orders the amount and checks the older person’s oxygen levels usually every six months (or more often if needed).  This is to see if the amount of oxygen needs to be changed. NEVER GIVE MORE OXYGEN than ordered.

Be sure that all prescribed medicines are taken

Even if the older person is feeling better and symptoms have disappeared, don’t stop giving the medicine.  Prescribed medicines for breathing should be taken until they are finished.  This will prevent a relapse (symptoms happening again). Contact the healthcare provider’s office before you stop giving the medicine or if the medicine is about to run out.  

Prevent problems from occurring

Ask the healthcare provider about a regular exercise program for the older person

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.  An exercise program can improve how well the older adult breathes.  Exercise also helps with general physical conditioning, which can lead to a better quality of life.  

There are a few things to consider when helping the older person with an exercise program.  The older person should not exercise right after a large meal, in extreme heat, or during periods of high humidity or air pollution. You should also make sure that the older person has less risk of falling during exercise. People who already have shortness of breath should check with their healthcare provider before starting an exercise program.  They may refer the older person to a rehabilitation program for patients who have COPD and heart disease. These programs are often covered by Medicare and other health insurance plans.

Encourage walking

Walking is good exercise and can be done almost anywhere, such as the halls of an apartment building, a shopping mall, outdoors, or even 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 healthcare providers 

They can provide counseling, motivation, medicines, and can recommend programs that have helped other patients.

Stop-smoking programs 

Many hospitals and medical centers offer stop-smoking programs and these are often free. Call to see what is offered in your area. If the older person is unable to attend the program, 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 audio 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 the American Cancer Society

These 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 benefit from following a regular nighttime routine. This can help them experience fewer or less severe breathing symptoms. For example, the older person should avoid eating or drinking coffee or alcohol immediately before going to bed. If the older adult takes a while to fall asleep, they should get out of bed and read or watch TV until feeling sleepy. 

Avoid sleeping pills

All people with lung problems should avoid taking sleeping pills (also known as sedatives), even ones that are available with a prescription. These medications can slow down breathing.

Discourage drinking alcohol

Alcohol increases the amount of secretions in the lungs.  This can make breathing problems worse. Alcohol can also make sleep apnea and other sleeping problems worse. 

Make sure immunizations are up to date

All people 55 years and older should get regular vaccinations.  So should anyone with lung problems. The flu (influenza) vaccine should be given yearly. The vaccine for pneumococcal disease (which can cause pneumonia) should be given at least once and about every seven to ten years after that.

Maintain good nutrition to avoid weight loss

Help the older adult maintain good nutrition to avoid weight loss (unless the person you are caring for is obese). People with poor nutrition can be less able to fight off infections. 

What to do about breathing problems during sexual activity

The older adult you are caring for may have some breathing problems during sexual activity.  You can give them the following information about how to manage breathing problems during sex:

  • Mild shortness of breath is not a cause for concern. 
  • The pace should be decided on by the partner with the breathing problem. These issues should be discussed frankly between the partners and their healthcare provider. 
  • The older adult can try new, less strenuous positions after asking a healthcare provider or a physical therapist.
  • Oxygen during sexual activity often helps to reduce breathing symptoms. Exercise testing can be used to figure out how much oxygen is needed.

Carrying Out Your Plan

Even when you have excellent plans, there may be obstacles or problems that prevent you from carrying them out. Here are examples of beliefs that might get in the way of carrying out your plan and possible responses.

"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, such as climbing stairs and carrying the groceries, breathing should not limit what a person can do. Wheezing, coughing, and shortness of breath are not normal at any age.

"I'm too frail or weak 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 healthcare providers, who can give names of programs in your community and give the older person specific advice on how to start. 

"It's too late for me to stop smoking."

Medical studies show it is never too late. Older people who quit smoking can have 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 guide? 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? You need to make plans for solving these problems. 
 

Checking on Progress

Do not expect to see positive results immediately. Improving breathing problems is a long-term project. It usually takes 3 to 6 months to see a noticeable improvement. The healthcare provider 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. You can also review your plan with a home health nurse. They are often knowledgeable about creating wellness programs and checking on the progress.

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 a person’s body to respond to treatment.

If breathing problems are increasing, ask the healthcare provider for help. Tell them what you have done and what the results have been.

Updated July 2015