People with leukemia commonly experience shortness of breath, also called dyspnea. This symptom occurs when you feel like you can’t take in a full breath of air. It can make everyday activities like walking or climbing stairs much more difficult.

Shortness of breath may feel like a little bit of breathlessness, or it may be more extreme, making you feel like you’re suffocating. It can also be accompanied by feelings of weakness or tightness in the chest, a faster heart rate, or clammy skin. You may feel short of breath only while doing an activity such as exercising or talking. You may notice this sensation even when you’re resting.

About 1 out of 3 people experience breathlessness during the early stages of leukemia. People with any type of leukemia can develop this symptom.

Many members of MyLeukemiaTeam have experienced shortness of breath. “The leukemia complicates everything due to fatigue and shortness of breath,” wrote one member. “I am trying to remain positive and see slow progress daily.” Another member added, “I get so tired and short of breath. Cleaning around the house is too overwhelming.”

Potential Causes of Shortness of Breath

People living with leukemia may experience shortness of breath for many reasons. This symptom is most often caused by leukemia itself. It may also be caused by leukemia treatments, other health conditions, or other external factors.

Anemia

For people with leukemia, shortness of breath is often caused by anemia.

Anemia is a condition that leads to low levels of red blood cells. These cells are responsible for carrying oxygen around the body. The body is constantly making new blood cells as old or damaged cells die.

In people with leukemia, cancer cells can fill up the bone marrow, the tissue inside of certain bones where new blood cells are made. As a result, the body can’t make as many new red blood cells.

Besides shortness of breath, symptoms of anemia include:

• Tiredness or weakness
• Dizziness
• Abnormal heart rhythms
• Chest pain
• Headaches
• Cold hands or feet
• Pale or yellowish skin
• Trouble concentrating or focusing

Anemia and breathing problems can develop in any type of leukemia. People with faster-growing types of leukemia — acute myeloid leukemia and acute lymphoblastic leukemia — may experience shortness of breath during the early stages of their condition.

Those with types of leukemia that come on more slowly, such as chronic myeloid leukemia (CML) and chronic lymphocytic leukemia (CLL), may not experience shortness of breath until later stages when their condition gets worse.

Leukemia Treatment Side Effects

Shortness of breath can be a side effect of treatments like chemotherapy, targeted therapy, or radiation. You may want to ask your doctor whether your cancer treatments are known to lead to difficulty breathing.

Drugs like chemotherapy can kill cancer cells, but they also destroy many of the body’s healthy blood cells. These treatments can cause anemia, leading to shortness of breath.

They may also kill white blood cells, which are important for fighting germs. Low levels of white blood cells can increase your risk of infections. Lung infections like pneumonia may lead to breathing problems.

In rare cases, the targeted therapy drugs used to treat CML can cause fluid to build up in the lungs, leading to shortness of breath. “I am taking a targeted therapy, and I am short of breath lately,” said one MyLeukemiaTeam member with CML. Another member on a different targeted therapy commented, “Shortness of breath comes and goes. Always tired.”

Radiation therapy to the chest can also lead to shortness of breath because it can cause lung inflammation. Radiation treatments are not often used as a part of leukemia treatment, but they may be used in certain situations. For example, a person may receive total body irradiation before undergoing a stem cell transplant. In rare cases, radiation may be used to treat cancer cells that have spread to certain bones or to treat tumors that are pressing against the airways.

Having Other Health Conditions

Shortness of breath can also be a symptom of other medical conditions that may occur alongside leukemia, such as:

• A chest infection such as pneumonia
• Low blood pressure levels
• Lack of physical fitness
• A panic attack
• Anxiety
• A heart attack
• Heart disease
• A pulmonary embolism (a blood clot that develops in the lungs)
• Lung conditions such as asthma or chronic obstructive pulmonary disease
• Carbon monoxide poisoning
• Nutritional deficiencies of iron, vitamin B12, and folic acid

Some MyLeukemiaTeam members have found that their shortness of breath was caused by other conditions besides cancer. “I have told my doctor about the shortness of breath, and he says it’s my anxiety,” one member wrote.

Other Factors

You can also experience shortness of breath as a result of other external factors. Spending time at high altitudes can sometimes cause this symptom. Breathlessness may also be caused by intense physical activity or extreme temperatures. People who smoke cigarettes may develop breathing problems such as shortness of breath.

Other factors could also impact breathlessness. “Rain and humidity make it more difficult sometimes,” one MyLeukemiaTeam member reported.

Shortness of Breath With CLL

CLL is the most common type of leukemia, and lung issues are known to sometimes occur among people with this condition. Complications from CLL that affect the lungs or airways can lead to shortness of breath.

For people with CLL, breathing issues may occur due to the reasons noted above, which relate to all leukemia types, or because of:

• Fluid buildup in the lining of the lungs (pleural effusion)
• A rare condition called pathologic leukemic bronchopulmonary infiltration (LBPI)

LBPI can occur when leukemia cells collect in or near the lungs.

These issues typically don’t occur until CLL is at an advanced stage or if it’s left untreated. Because shortness of breath can affect your quality of life or impact your ability to perform daily activities, it’s important to talk to your cancer care team to find solutions.

Additionally, in CLL, around 10 percent of patients may develop shortness of breath due to autoimmune hemolytic anemia. This is a condition in which your immune system produces substances called antibodies that destroy your red blood cells.

Treating Shortness of Breath

When you notice that you’re feeling out of breath, there may be a few things you can do to make breathing easier:

• Sit up straight, or prop your upper body up to a 45-degree angle while lying down.
• Practice pursed-lip breathing. Inhale slowly through your nose, pucker your lips as if you were going to blow out a candle, and then breathe out as much air as possible. Try to make your exhales twice as long as your inhales.
• Sit up with your feet on the floor or a stool. Place your arms on a tray table or side table in front of you, and tilt your head forward.

You can also ask your doctor if there are any treatments that will help you breathe better. Your doctor may be able to prescribe oxygen therapy, inhalers, nebulizers (machines that deliver medication in the form of a mist that you inhale), or other medications that reduce inflammation in your lungs or help open your airways.

Treating the Causes of Breathlessness

In the long term, you can reduce breathlessness by addressing its underlying cause. For example, anemia may be treated with iron supplements as well as iron infusions (a treatment in which iron is given directly into your veins). Red blood cell transfusions (where you receive new red blood cells from a donor) can help. Medications called erythropoiesis-stimulating agents, which are injections that help your body produce more red blood cells, may also be beneficial. Erythropoiesis is the process of making new red blood cells.

Your doctor may recommend taking antibiotics to prevent or treat infections, including chest infections. You may also take medications such as growth factors to raise your white blood cell counts.

If your shortness of breath is caused by a leukemia treatment, talk to your doctor about switching to a different medication. Some MyLeukemiaTeam members reported various side effects while trying different treatments. One member with CML wrote, “If shortness of breath is there, call your doctor. What works for one person doesn’t always work for another.”

Other health conditions that cause shortness of breath are treated in different ways. Work with your doctor to describe your symptoms and come up with solutions that work for you.

“It seems my shortness of breath was asthma-related,” said one member. “Breathing a sigh of relief. For now, all I need is an inhaler several times per day.”

Is Shortness of Breath Serious?

Shortness of breath may not always seem significant. Some people with this symptom dismiss it as a sign that they’re not as physically fit as they used to be. However, breathlessness can sometimes be a sign that you have a more severe underlying problem.

One of the most serious forms of shortness of breath is breathlessness that appears quickly, out of the blue. This can sometimes be a sign of something major, such as a heart attack. Seek emergency medical care — such as calling 911 — if you have sudden shortness of breath along with other worrisome symptoms such as chest tightness, trouble talking, dizziness, or blue-tinged skin or fingernails.

Even when breathing problems don’t signal a major problem, it’s still important to let your health care team know what’s going on. Changing symptoms may be a sign that your leukemia is getting worse or that you’re experiencing another health problem. Tell your doctor if:

• Shortness of breath comes on suddenly and unexpectedly.
• You become breathless while performing easy tasks that previously didn’t cause you any problems.
• You have shortness of breath that lasts for a month or more or gets worse over time.
• Coughing symptoms appear along with shortness of breath.

MyLeukemiaTeam members have reported talking to their doctor about their breathing problems. “The last time I was at the oncologist, she asked me, ‘Are you short of breath?’” said one member. “Be sure to let your oncologist know about this. It’s important you do.”

Talk With Others Who Understand

MyLeukemiaTeam is the social network for people with leukemia and their loved ones. On MyLeukemiaTeam, more than 18,000 members come together to ask questions, give advice, and share their stories with others who understand life with leukemia.

Do you have shortness of breath? Share your experiences in the comments below, or start a conversation by posting on your Activities page.