Changes in Breathing in Advanced Illness and at End-of-Life

Breathing changes can be scary to watch, but they are very normal in advanced disease. Often the patient feels no distress, even when family does.

To ease shortness of breath: raise the head of the bed, use a fan to blow cool air across the face, keep the room calm, try pursed lip breathing, do oral care, open a window, loosen clothing, use a cold cloth on the forehead, and check oxygen tubing for kinks. If your loved one can't tell you, watch for restlessness, grimacing, tugging at the collar, or visible pulling of muscles at the neck or ribs.

If oxygen is used: avoid oil or petroleum products near the nose or lips, ask about humidification, never allow smoking nearby, and watch for skin irritation around the ears.

At end of life, breathing may become irregular or shallow with long pauses. A "rattle" sound from pooled secretions is common and usually isn't distressing to the patient. Oral care and repositioning help, and some people benefit from medication, so talk to your health care team.