This page is part of the PanCare PLAIN summaries about late effects and recommendations for long-term follow-up care for survivors of childhood, adolescent, and young adult cancer. Click here, for more information on the PLAIN summaries.

Lung problems

Our lungs are essential for breathing and located in our chest on each side of the heart. When we breathe in, tiny air sacs in the lungs take up oxygen, which is then transported through the bloodstream to all parts of the body. When we breathe out, carbon dioxide is removed from the blood and released into the air.

Sometimes problems can occur with the lungs. Cancer treatment may cause problems with the lungs including the air sacs becoming damaged or lungs becoming stiff and not expanding as well when breathing. Lung problems that may occur in the general population and in survivors include:

  • Pulmonary fibrosis, where the lungs become scarred over time.
  • Frequent chest infections, for example pneumonia.
  • Chronic obstructive pulmonary disease (COPD), where the airway tubes in the lungs are narrowed and make it harder for the air to flow in and out of the lungs.
  • Chronic bronchitis, where the lungs are constantly inflamed. This causes the lungs to produce more mucus, which makes it harder to breathe.

There are a number of things anyone can do that may lower the risk of lung problems, such as avoiding smoking.

Am I at higher risk of lung problems?

Anyone, including people who have never had cancer treatment, may develop lung problems. However, there are some cancer treatments that may increase the risk of having lung problems later in life. The problems that can occur depend on the type of cancer treatment received.

The following treatments can increase the risk of lung problems:

  • Chemotherapy drugs carmustine (also known as BCNU), lomustine (also known as CCNU), busulfan and bleomycin. Bleomycin can cause pulmonary fibrosis which may be made worse if high oxygen concentrations are given at a later date (for example during surgery).
  • Radiotherapy to the lungs or an area that includes the lungs
  • Stem cell transplantation with stem cells from a donor (allogeneic)
  • Surgery of the chest

You can find out if you have received any of these treatments by looking at your treatment summary. If you do not have a treatment summary or if you have any questions, do contact your treating hospital.

If you experience lung problems, it does not always mean that this is caused by your cancer treatment. Lung problems may have other causes, such as smoking, being overweight and older age. For more information on being overweight and obese, please read: Overweight and obesity.

What are the symptoms and signs of lung problems?

There are symptoms and signs that can tell you if you might have lung problems. You might not have these symptoms and signs at the moment, but it is important to be aware of them in case they may develop in the future.

These symptoms and signs may suggest that you have lung problems:

  • Shortness of breath or difficulty in breathing
  • A cough that does not get better
  • A decrease in ability to exercise
  • Pain or discomfort when breathing in or out
  • Coughing up mucus or blood

If you recognise any of these symptoms or signs in yourself, please contact your general practitioner or follow-up care specialist.

I am at higher risk of lung problems. What tests should I have and when?

If you are at higher risk of lung problems, it is advised to:

  • Discuss your medical history and whether you experience(d) any symptoms and signs of lung problems with your general practitioner or follow-up care specialist. This should be done at least every 5 years.
  • Have a physical lung exam at least every 5 years. During a physical lung exam, the doctor will inspect your chest and breathing.
  • Have lung function tests once at entry into long-term follow-up (LTFU). A lung function test tells you how well your lungs are working. This test may be repeated more often if you show other signs of lung problems.

What happens if I have lung problems?

If you have lung problems, your general practitioner or follow-up care specialist will probably refer you to a:

  • Respiratory physician (physician specialised in the lungs)

The respiratory physician may discuss different treatment options with you.

What else can I do?

Knowing that you may be at increased risk of lung problems can be difficult. Talking to friends and family can be helpful as well as specialist counselling and/or contact with support groups, such as patient organisations. For more information on taking care of your mental health, please read: Mental health problems.

To lower your risk of lung problems, adopting or maintaining a healthy lifestyle is extremely important. In particular, it is important to avoid smoking (cigarettes, vapes, cigars, pipes and breathing in second-hand smoke) and being exposed to polluted air or working with harmful substances. Taking care of your mental health may be beneficial; even small changes to your lifestyle can have a positive impact on both your physical and mental health. For more information on taking up a healthier lifestyle, please read: Health promotion.

To reduce your risk of pneumonia, you may want to consider vaccination against pneumococci. Pneumococci are bacteria that can cause pneumonia. Sometimes pneumonia can also occur when you have the flu. Therefore, yearly vaccination against the influenza virus may help in preventing the development of lung problems. You can discuss with your general practitioner or follow-up care specialist whether it is necessary for you to get vaccinated and the benefits of vaccination.

It is important that you are aware of the possibility of developing lung problems and that you know the symptoms and signs. If you have any further questions or if the information in this brochure concerns you, please contact your general practitioner or follow-up care specialist.

Where can I find more information?

You may find more information about lung problems online. However, it is important to be aware that this information is not always up to date or accurate.

Some sources of further information are:

  • Together: Here you can find more information about lung and breathing problems

On this website, you can also find more information related to this topic:

Please note

This PLAIN summary is based on the PanCareFollowUp guideline about “Pulmonary problems” [1], which is based on the consensus of different national guidelines.

While the PanCare PLAIN information group strives to provide accurate and complete information that is up-to-date as of the date of publication, you can check with your general practitioner or follow-up care specialist if this summary reflects the most up-to-date information available and whether it is relevant for you.

Please do not rely solely on this information. It is best to also seek the advice of a qualified medical practitioner if you have questions regarding a specific medical condition, disease, diagnosis or symptom.

No warranty or representation, expressed or implied, is made concerning the accuracy, reliability, completeness, relevance, or timeliness of this information. PanCare has produced the English version and PanCare is not responsible for the translated versions of this summary.

The PanCare materials are free to use for anyone aiming to inform about late effects and long-term survivorship care. However, no financial advantage may be achieved. All communication should reference PanCare and link to the PanCare website.

[1] van Kalsbeek, R. et al. (2021) European PANCAREFOLLOWUP recommendations for surveillance of late effects of childhood, adolescent, and Young Adult Cancer, European journal of cancer. Available at: