How to Manage Sudden Breathlessness With IPF

It can be very scary when you feel like you can’t breathe. You may feel like you’re running out of air or just can’t breathe deeply enough. Shortness of breath, called dyspnea, is a common symptom of idiopathic pulmonary fibrosis (IPF), a chronic condition in which lung tissue becomes thick and stiff.

“Few symptoms are as frightening as feeling like you cannot catch your breath,” says Nirav G. Shah, MD, clinical chief of pulmonary, critical care, and sleep medicine at the University of Maryland Medical Center in Baltimore. “Breathlessness can trigger anxiety, which in turn can make breathing feel even harder.”

“For individuals with a chronic lung condition like idiopathic pulmonary fibrosis, knowing a few simple techniques can help you regain control and reduce distress while you assess whether you need medical attention,” Dr. Shah says.

“This is one of the most effective and accessible techniques for managing acute breathlessness,” says Jamie Garfield, MD, a medical spokesperson for the American Lung Association and a professor of thoracic medicine and surgery at the Temple Lung Center at Temple University Hospital in Philadelphia.

“Exhaling through pursed lips creates a gentle back pressure inside the airways that acts like an internal splint, keeping the small airways open longer, so that otherwise-trapped air can escape more completely before the next breath,” she says. Each new breath can then bring in fresh, oxygen-rich air.

Jamie Lederer, the outreach director for clinical affairs at the Pulmonary Fibrosis Foundation, explains step by step how to do it:

• Relax your neck and shoulder muscles.
• Slowly inhale through your nose with your mouth closed for two seconds.
• Pucker (or purse) your lips — like you’re blowing out a candle.
• Breathe out slowly through your pursed lips for four seconds.
• Repeat this pattern.

“The diaphragm is a stronger and more efficient breathing muscle than the accessory muscles in the neck and upper chest,” says Dr. Shah. “Engaging the diaphragm helps the lungs expand more fully, reduces the work of breathing, and conserves energy during episodes of breathlessness.”

Lederer explains this technique using the following steps:

• Sit or lay down with one hand on your stomach and one on your chest.
• Breathe in deeply through your nose, keeping your chest still and allowing your abdomen to expand.
• Slowly and gently breathe out through pursed lips like you’re blowing bubbles.
• Continue this pattern slowly, focusing on feeling your stomach rise and fall with your breathing.

“Certain physical postures naturally reduce the workload on the lungs by optimizing how the diaphragm moves and reducing the effort needed to inhale,” says Dr. Garfield. “Forward-leaning positions improve dynamic lung compliance, lower the pressure the diaphragm must generate to move air, and reduce the neural drive needed to breathe — all of which translate to less perceived difficulty breathing.”

Garfield suggests trying the following positions:

• The tripod position (sitting, leaning forward with hands on knees) is the single most effective posture to help shortness of breath, allowing gravity to help your diaphragm descend more easily, taking pressure off your lungs and reducing the total work of breathing.
• Sitting and leaning forward with your arms resting on a table has similar benefits to the tripod position and may be more comfortable for longer periods.
• Standing and leaning forward with your arms braced against a wall or counter can help if you can’t get to a chair.
• Sitting straight upright in a bed or in a chair with your back supported and your arms resting on cushions or pillows can help you rest.
• An elevated lying position (propped up on pillows or in a recliner at about 45 degrees) is far preferable to lying flat. Lying flat is typically the worst position for breathlessness because it compresses your diaphragm under the weight of your abdominal organs.

“Supplemental oxygen is prescribed by your care team when your oxygen levels are low,” says Lederer. “Some individuals will need to wear their oxygen at rest and with activity, and others will only need it when they are active.”

During a flare-up of breathlessness, Garfield says there are several things to keep in mind:

• Follow your doctor’s instructions exactly: Breathlessness doesn’t necessarily mean you need to adjust your oxygen. “Some patients can be very short of breath with normal oxygen levels,” Garfield says. “Arbitrarily increasing the flow can mask worsening symptoms that need urgent medical attention and, in some clinical situations, can cause harm.”
• Check your oxygen level with a pulse oximeter, a device that fits over a fingertip. That will guide whether supplemental oxygen is needed.
• Make sure your oxygen equipment is functioning properly. Check that the tubing isn’t kinked, the cannula (the part that fits inside your nostrils) is positioned correctly, and the tank or concentrator has adequate supply.

“Your oxygen prescription should be based on formal testing, such as a six-minute walk test or overnight oximetry, and should be reassessed periodically,” says Garfield. “Keep oxygen equipment accessible and in good working order, and know how to use it.”

• Your breathlessness is sudden, severe, and not relieved by rest, positioning, or supplemental oxygen.
• Your lips, fingertips, or face turn blue or gray.
• Chest pain or tightness accompanies the breathlessness.
• You feel confused, dizzy, or faint.
• Your breathlessness suddenly prevents you from speaking in full sentences.
  
  

She says to call the doctor for less urgent symptoms, such as:

• Your breathlessness is noticeably worse than usual over several days.
• You develop a new or worsening cough, possibly with fever or flu-like symptoms.
• You need more supplemental oxygen than you’ve been prescribed.
• You have swelling in your legs or ankles or unexpected weight gain, which could indicate heart failure.

“When in doubt, seek help promptly,” says Shah. “Severe breathing difficulties should always be treated as a medical emergency.”