Breathing problems and help at home

Breathlessness does not usually announce itself. It arrives as a series of small edits. The washing gets hung in two trips instead of one, then the sheets stop being changed weekly, then the visit to a friend across the suburb becomes a phone call.

By the time anyone names it, a good deal of life has already been quietly given up.

This guide is general information, not clinical advice. Any change in breathing belongs with your GP, and anything sudden belongs with an ambulance.

The cycle that does the damage

Breathlessness is uncomfortable, so people do less. Doing less makes muscles weaker. Weaker muscles need more oxygen for the same task, so the same task now causes more breathlessness.

That loop is the thing most worth interrupting, and it is the reason the advice below is about doing things differently rather than doing less of them. Rest is not the treatment. Pacing is.

Pacing, which is not the same as slowing down

Pacing means breaking a task into pieces with planned stops, before you need them. It sounds trivial and it changes what a person can get through in a day.

In practice:

• Sit down for anything that can be done sitting. Showering, dressing, chopping vegetables, ironing. Standing is work.
• Put a chair where you run out. Halfway down the hall, at the top of the drive, beside the clothesline. A resting point placed in advance turns a trip you avoid into a trip you make.
• Split the task, not the day. Half the bed now and half after a cup of tea beats abandoning it.
• Breathe out on the effort. Out as you stand, lift or push, rather than holding your breath. Holding is instinctive and it makes everything harder.
• Push things instead of carrying them. A trolley, a wheeled basket, a bag on a chair with wheels.
• Do the hard things at your best hour. For most people that is mid-morning. Working out when yours is takes a week of paying attention and pays back permanently.

Let the house take some of it

Several ordinary changes reduce how much work a day requires.

Move what is used daily to between hip and shoulder height, so nothing routine needs a bend or a reach. Get a shower stool and a long-handled sponge. Keep a set of the things you use most in each end of the house, so a forgotten item does not cost a return trip. Warm still air is harder than moving air, so a fan is worth more than it looks.

An occupational therapist does exactly this work and does it better than a guess, because they watch the actual tasks in the actual rooms. What an occupational therapist does covers how to get one and what to expect.

Exercise is the counter-intuitive part

The instinct is to protect the lungs by resting them. The evidence runs the other way: supervised exercise improves breathlessness, because stronger legs demand less oxygen.

It has to be set by someone qualified, and the dose is what people get wrong. A physiotherapist or exercise physiologist can build something that starts at the right level and actually gets harder over time. Physiotherapy at home for older people and the wider allied health at home cluster explain how those visits are arranged.

Where support at home fits

The honest division is simple. The tasks that cause the most breathlessness for the least reward are the domestic ones, and those are the ones to hand over first.

Bed changing, vacuuming, hanging washing, carrying shopping in from the car. Handing those over is not the beginning of decline. It is what frees the capacity for the things a person actually wants to spend their breath on.

Showering is the other one worth naming, because it combines heat, steam, standing and arms above the head, which is close to a worst case. Help there, from someone the same each week, changes the day. That is what personal care is for.

When to ring, and when to ring an ambulance

Ring the GP within a day or two for breathlessness that is worse than usual over a week, a cough that has changed, more swelling in the ankles than normal, or needing more pillows at night than you used to.

Ring 000 for sudden severe breathlessness, chest pain, blue lips, or confusion that has come on quickly. The last one catches families out, because it does not look like a breathing problem.

Everyone with a long-term lung condition should have a written plan from their doctor for what to do when things worsen. If there is not one, ask for it.

Where consistency earns its keep

Breathlessness is measured in comparisons, not in single days, and a comparison needs somebody who was there last week.

At Aldera the pacing plan, the best hour of the day and the tasks that cost the most sit in the One Story record rather than in one worker’s memory, and the same small Care Circle comes back, so a week where the hallway got harder is noticed as a change.

For what is funded and how it is arranged, start at myagedcare.gov.au and raise breathlessness specifically at your assessment.