Breathlessness (Dyspnea)
Dyspnea is defined as an uncomfortable awareness of breathing.
Breathlessness can be related to factors not involving physical disorders. These include rapid breathing after hard exercise, the effects of high altitude, or simply the sensation of needing a breath.
Treatment of dyspnea is best aimed at the underlying cause. When heart or lung disease can be improved, the sensation of dyspnea is often greatly ameliorated. Severe restrictive lung disease as manifested by pulmonary fibrosis or neuromuscular abnormality poses a particularly difficult problem. In these cases the complaint is often permanent and debilitating. The most effective treatment of dyspnea in cases of far-advanced pulmonary fibrosis is single lung transplantation.
Breathing in a healthy man is an involuntary activity controlled from the breathing centres in the brain. This centre can increase ventilation in excess of requirements in conditions such as fear, anxiety and exertion. A normal resting person is unaware of the fact of breathing and while he may become conscious of breathing during mild to moderate exertion, no discomfort Is experienced.
Being short of breath is always scary. Breathlessness that persists requires medical evaluation.
Breathlessness can be due to a heart or lung problem such as:
- lung damage from smoking or exposure to dusts or chemicals
- asthma, emphysema, and airway obstruction
- restrictive diseases, such as fibrosis of the lungs
- lung cancer
- pneumonia and other infections
- a collapsed lung
- blood clots in the lung and
- poor blood supply to heart muscle
Sometimes emotional distress, such as anxiety, can lead to difficulty breathing. Specific causes of Breathlessness include the following:
- Lung disease
- Cigarette smoking
- Asthma
- Emphysema
- Coronary artery disease
- Heart attack (myocardial infarction)
- Interstitial lung disease
- Pneumonia
- Pulmonary hypertension
- Rapid ascent to high altitudes, with less oxygen in the air
- Airway obstruction
- Inhalation of a foreign object
- Dust-laden environment
- Allergies (such as to mold, dander, or pollen)
- Congestive heart failure (CHF)
- Heart arrhythmias
- Deconditioning (lack of exercise)
- Obesity
- Compression of the chest wall
- Panic attacks
Grades of Dyspnea
There are four determining grades as follows:~
1. Grade I : Breathlessness during unaccustomed exercise
2. Grade II : Breathlessness during accustomed exercise
3. Grade III : Breathlessness during less than accustomed exercise
4. Grade IV : Breathlessness at rest
Types of Dyspnea
1. Nocturnal Dyspnea: Dyspnea, which occurs only at night and may be paroxysmal as in patients with heart failure.
2. Orthopnea: Here dyspnea occurs when a patient liesdown as in cases with heart failure, asthma and chronic obstructive disease of the lungs.
3. Trepopnea: This is used to describe the appearance of breathlessness only in the left or right lateral lying position. This does not occur When a patient is In the supine position. This occurs in patients with heart disease.
4. Platypnea: Is breathlessness, which occurs only in the upright position.
Management
1. Dyspnea is a serious symptom and thus requires consultation at the earliest.
2. Prop the patient up in bed.
3. Quit smoking immediately.
Diagnostic tests that may be performed include the following:
- Blood tests including arterial blood gases
- Measurement of blood oxygen saturation (pulse oximetry)
- ECG
- X-ray of the chest
- Pulmonary function tests
- Exercise testing
- CT scan of the chest
- Echocardiogram
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