(Shortness of breath / Cough / Lung infections / Tests / Looking after your Lungs)

Late effects on the lungs following chemotherapy

Most people who have treatment for cancer as a young adult will not get lung problems. Lung problems can develop during or shortly after treatment finishes. They can also happen a long time after treatment.

Some cancer treatments can cause long-term lung problems. These include:

• Chest surgery
• Some chemotherapy drugs, for example Bleomycin, Methotrexate, Cyclophosphamide

Signs of lung problems include:

• Shortness of breath or wheezing
• A cough that doesn’t get better
• Getting lung infections regularly
• Chest pain
• Feeling very tired

If you notice any of these symptoms, it’s important to tell your doctor. Symptoms can vary from person to person. They are often mild but can sometimes be more severe. It is possible for other things to be causing them too.

Your doctor may recommend some medications to help. There are also ways you can help to look after your lungs. These include not smoking, doing breathing exercises, and being active.

Possible lung problems

Your doctor might arrange some tests during chemotherapy treatment to check how well your lungs are working. This means they can adjust treatment if they notice any early changes with your lungs. Lung problems caused by cancer treatment can develop during or shortly after treatment finishes. They can also happen a long time after treatment. Sometimes they can happen many years afterwards. If you think you are getting new symptoms, it’s important to tell your doctor. 

The problems we list here can sound a bit scary. But remember, they do not happen often. If any of these problems affect you, there are treatments to help manage them.

Inflammation in the lungs (acute pneumonitis)

The chance of this happening is increased if you have higher doses of chemotherapy. Remember, the treatment team carefully work out the dose of chemotherapy you need to have. This allows them to treat the cancer, but also to cause as few side effects as possible. 

Pulmonary fibrosis

This is when the tissues between and around the air sacs in your lungs become scarred and grow thicker. This can make it harder for oxygen to get from your lungs into your blood.

Bronchiectasis and lung infections

The lungs are full of tiny airways called bronchi. The lining of these is covered in a sticky fluid called mucus. After treatment, some of these airways can become too wide (bronchiectasis). This can lead to mucus building up in the airways, making you more likely to get lung infections.

Chronic bronchitis

The airways in your lungs can become swollen and irritated. This can make your lungs produce extra mucus.

Tests for lung problems

If you’re worried you might be getting problems with your lungs, your doctor will examine you. They will check whether any cancer treatments you had could cause lung problems.

They might want to do some tests to look at your lungs in more detail. These might include: 

• Lung function tests
• A chest X- ray
• A chest CT scan
• A bronchoscopy (a tube with a camera that helps the doctor or nurse see inside the airways of the lungs)

If you had bleomycin as part of your cancer treatment, it is important to tell this to doctors if you ever need to have oxygen. High doses of oxygen can be dangerous for people who have lung damage caused by bleomycin. The doctor will carefully adjust the amount of oxygen you get. If you need to have a general anaesthetic and you have had bleomycin, remember to tell the anaesthetist. If you need general anaesthetic for a dental procedure, remember to tell your dentist.

It is also important not to use oxygen as a recreational drug.

Shortness of breath

Cancer and its treatments may cause breathlessness. There are different ways to help manage breathlessness. See below for more support

Breathlessness | Macmillan Cancer Support

Managing and treating breathlessness | Macmillan Cancer Support

How your doctor can help | Coping physically | Cancer Research UK

Breathing and relaxation techniques | Coping with cancer | Cancer research UK

Ongoing cough

An ongoing cough after cancer treatment is a common, often chronic symptom caused by lingering treatment effects, a cough that does not go away can be distressing and tiring. It can interfere with your daily life. For example, coughing may affect your sleep.

Common causes can be:

• Chemotherapy: Causing irritation, increased mucous production or persistent lung inflammation
• Targeted Therapy & Immunotherapy: Known to cause coughing as a side effect.
• Infections: Post-treatment immunity may be low, making you susceptible to infections that cause a cough

Tell your GP straight away if you are coughing up blood

Top tips for managing a cough:

• Make sure you drink enough. Drinking plenty of fluid can make mucus thinner.
• Always tell your GP if your cough gets worse, or if you start coughing up yellow or green mucus (phlegm). You may have an infection and need antibiotics..
• Codeine or morphine are drugs that are usually used to control pain. But they can also be used to treat an ongoing cough, even if you do not have pain. •

If you have a dry, irritable cough, your healthcare team may prescribe a cough medicine to help. You can buy some cough medicines at supermarkets or pharmacies. Talk to your doctor or pharmacist before you buy anything to help with a cough.

• Sometimes a steam inhalation or breathing in salt water (saline) through a nebuliser can help. This can help clear thick mucus from the airways.
• Smoking increases your risk of lung problems. If you smoke your doctor will usually advise you to stop smoking. It can be difficult to stop smoking, especially when you are stressed. Using the NHS Stop Smoking Services improves your chances of success. Your GP can also give you support and advice.
• Relaxation exercises may help you manage a cough

Some people find the stress of a cancer diagnosis or treatment can increase the amount they smoke or vape, which can lead to other health concerns such as an ongoing cough or shortness of breath

For support with this you can speak to your GP or search for local support on the link below:

• Find stop smoking support services - NHS

Looking after your lungs

It’s not always possible to cure lung problems caused by cancer treatment. But there are lots of things that can help. Your doctor might give you medicines, but there are also things you can do to help. These include:

• Keeping active and exercising
• Using special breathing exercises and techniques – your doctor can refer you to a physiotherapist who can teach you
• Eating well and maintaining a healthy diet
• Stopping smoking – you can ask your GP or local pharmacy for advice or go to the NHS Better Health website
• Having vaccinations to reduce the chance of a lung infection – for example, every winter you could have the flu vaccination

Support

If you have developed a lung problem after cancer treatment, you may need support. Some people feel angry or upset at having a new problem to cope with after all they have been through. Speak to your doctor or nurse. They can refer you to a counsellor or someone else who can help you understand these feelings. They can also suggest ways to manage them. 

Remember, not everyone has problems with their lungs after treatment. But it’s important to speak to your treatment team if you think you might be getting any problems.

You can find out more about lung problems from Asthma + Lung UK. 

For more information on the effects on the lungs, please follow the below links:

• Lung problems | CCLG - The Children & Young People's Cancer Association
• Late effects - Lung issues | CCLG - The Children & Young People's Cancer Association
• Late effects - Lung issues: After bleomycin treatment | CCLG - The Children & Young People's Cancer Association
• Understanding the late effects of cancer treatment | Macmillan Cancer Support