ضيق النفس
من ويكيبيديا، الموسوعة الحرة
اذهب إلى: تصفح، بحث
ضيق النفس (بالإنجليزية: Dyspnea) هو إحساس بتعب وتضايق عند التنفس، أو الشعور بصعوبة التنفس. وضيق النفس عَرَضٌ له أسباب مختلفة غالباً ما تتعلق بأمراض الرئة أو القلب، ولكنها قد تتعلق باختلال في الشعور بنقس الأكسجين أو الهواء. ويبقى ضيق النفس شعور شخصيّ لا يمكن التحقق منه موضوعياً في كافة الحالات، إلا أن هناك أدلة واضحة تدل عليه مثل فحص مدى التشبّع الأكسجيني، ملاحظة ازرقاق المريض، مراقبة سرعة تنفسه أو ملاحظة المشقة المرافقة للتنفس،... الخ. يتم علاج ضيق النفس عن طريق تشخيص المرض الكامن وراء ضيق النفس، ومن ثم إزالة أسبابه، ولكن يمكن أيضاً علاج ضيق النفس علاجاً عَرَضياً بمشتقات المورفين، كما يتطلب علاج حالات ضيق النفس المستعصية والخطيرة استخدام الآلات للتنفس الاصطناعي.
محتويات
1 التعريف
2 الشرح الوظيفي لآلية ضيق النفس
3 أشكال ضيق النفس
3.1 درجات ضيق النفس
4 أسباب ضيق النفس
4.1 أمراض الرئة
4.2 أمراض الدوران الرئوي
4.3 أمراض المجاري التنفسية
4.4 أمراض القلب
4.5 اختلالات الدم والاستقلاب
4.6 اختلالات عضلية وعصبية
4.7 إعاقات الحجاب الحاجز
4.8 اضطرابات نفسية
5 علاج ضيق النفس
6 علم الأوبئة
7 المراجع
التعريف
يُعرّف ضيق النفس بأنه الإحساس غير الطبيعي والمزعج بالجهد المبذول للتنفس[1]. ففي الظروف الطبيعية لا يُدرك الأصحّاء بالجهد المبذول للتنفس، فيكون التنفس وكأنه بدون مجهود. تتم مراقبة التنفس والجهد التنفسي في مركز التنفس في الدماغ دون أن تصل تلك المعلومات إلى الوعي، لكن في الحالات التي يزيد فيها الجهد التنفسي بشكل ملحوظ عن الوضع الطبيعي، فإن هذه المعلومة تصل إلى الوعي البشري، فيشعر الإنسان أن هناك جهداً متزايداً مبذولاً للتنفس - كما يحدث أثناء الرياضة، وفي حالات الإرهاق يصل الحد إلى التضايق من الجهد التنفسي، مما يدعو الجسم لإيقاف الحركة. في هذه الحالة يكون "ضيق النفس" (اللّهاث) مقبولاً ومبرراً عند الشخص المُرهق، ويرافقه المعرفة بأن هذا الضيق سرعان ما يزول عند التوقف عن الحركة؛ لذلك لا يرافق ضيق النفس في هذه الحالات شعورٌ بالخوف ولا بالتضايق الشديد.
أما في الحالات المرضية التي تتطلب جهداً متزايداً للتنفس فإن إدراك هذا الجهد المتزايد يُرافقه شعور بالخوف، ويكون ضيق النفس في هذه الحالات مزعجاً جداً حتى ولو لم يسبب ألماً بالمعنى الحقيقي للألم، ولكن الشعور بضيق النفس قد يكون أكثر إزعاجاً من الآلام البدنية.
الشرح الوظيفي لآلية ضيق النفس
يتم تنظيم عملية التنفس في الدماغ في مركز التنفس الواقع في التَّشَكُّلُ الشَّبَكِيُّ للبَصَلَة (باللاتينية: Formatio reticularis medullae oblongatae)، حيث تلتقي المعلومات الواردة للدماغ والقادمة من مجسات الجهاز التنفسي في الرئة، وفي القصبات الهوائية، وفي العضلات التنفسية (عضلات القفص الصدري والحجاب الحاجز)، والمستقبلات الكيميائية الواقعة في التشكل الشبكي نفسه، والتي تقيس مستوى حموضة الدم، والضغط الجزئي لثاني أكسيد الكربون المذاب في الدم، والمستقبلات الكيميائية في جدار الأبهر وفي الكبة السباتية (باللاتينية: Glomus caroticus) الواقعة في الجيب السباتي والتي تقيس الضغط الجزئي للأكسجين في الدم[1].
عند نقص الضغط الجزئي للأكسجين أو زيادة الضغط الجزئي لثاني أكسيد الكربون في الدم، فإن التشكل الشبكي (مركز التنفس) يحفز عضلات التنفس للشهيق، وبنفس الوقت تعود إليه معلومات من هذه العضلات حول الجهد المبذول في ذلك. عند حصول خلل في هذه الآلية (مثل زيادة الجهد المبذول للتنفس عن المستويات الطبيعية، أو عدم تعويض نقص الأكسجين رغم زيادة تردد التنفس... الخ) يتم تنبيه قشرة الدماغ (مركز الوعي) بذلك، وينشأ عن ذلك الشعور بضيق النفس.
المريض الذي يُعاني من إرهاق عضلات التنفس يعمد إلى تخفيف الجهد المبذول في التنفس من خلال استغلال عضلات إضافية في عملية التنفس، فيعمد إلى تثبيت أطرافه العليا (الذراعين والكتف) إما بوضعهما على ركبه - كما يفعل العدّاء في نهاية السباق -، أو بالتمسك بما حوله من أجسام ثابتة، وذلك حتى تُساعد عضلات الكتف في عملية التنفس.
أما المريض الذي يُعاني من وذمة الرئة (تراكم السوائل في الرئة) فإنه يعمد إلى الجلوس لرفع الجزء الأعلى من الجسم حتى تنتقل السوائل إلى الأقسام السفلى من الرئة بفعل وزنها، تاركة الأقسام العليا من الرئة لتبادل الغازات، مما يخفف من الإحساس بضيق النفس. هؤلاء المرضى يعانون أكثر حين يستلقون بشكل أفقي لأن السوائل تتوزع على كافة أقسام الرئة، لذا فهم يعمدون إلى وضع الوسائد التي ترفع الجزء العلوي من الجسم أثناء النوم، حتى يتمكنوا من النوم.
أشكال ضيق النفس
يتم تقسيم ضيق النفس - بحسب السيرة المرضية - إلى عدة أقسام[2]:
ضيق النفس الجهدي (بالإنجليزية: Exertional dyspnea).
ضيق النفس الشديد اللاجهدي (بالإنجليزية: Severe dyspnea at rest).
ضيق النفس الوضعي (بالإنجليزية: Orthodyspnea) (ضيق نفس عند الاستلقاء، يخف عند الجلوس أو القيام).
ضيق النفس الوظيفي (بالإنجليزية: Functional dyspnea) (يظهر في أوضاع الراحة ويتم تناسيه أثناء الجهد).
درجات ضيق النفس
يتم تقسيم "ضيق النفس" (بحسب جمعية أطباء الصدر الأمريكية) إلى درجات تصف مدى حدّته إلى أربع درجات[3]:
الدرجة الأولى: ضيق النفس عند بذل جهد كبير (مثل صعود المرتفعات، صعود الأدراج للطوابق العليا، حمل الأوزان الثقيلة... الخ).
الدرجة الثانية: ضيق النفس عند بذل جهد عادي (مثل المشي في السهل أو الساحات المستوية، حمل الأوزان الخفيفة... الخ).
الدرجة الثالثة: ضيق النفس عند بذل جهد قليل (مثل ارتداء الملابس، التحرك داخل المنزل... الخ).
الدرجة الرابعة: ضيق النفس بدون بذل جهد أي في أوضاع الراحة، ومن ذلك "ضيق النفس أثناء التحدث" بحيث لا يتم المصاب جملته دون أن يقطع كلامه للتنفس؛ ويدعى ذلك أيضاً بضيق النفس التحدثي.
أسباب ضيق النفس
يشمل التشخيص التفريقي لضيق النّفس أسباباً عديدة، فكثير من الحالات المرضية تؤدي للشعور بضيق النفس من خلال إضرارها إما بعملية التنفس، أو من خلال الإضرار بآلية تنظيم التنفس نفسه. من هذه الحالات المرضية[3][4]:
أمراض الرئة
تتسبب أمراض الرئة بضيق النفس من خلال آليات مختلفة، فالتضيقات في القصبات الهوائية (كما يحدث في الربو أو التهاب القصبات مثلاً) يزيد مقاومة المجاري التنفسية للهواء، وبالتالي يرفع من الجهد المطلوب للتنفس. وأمراض الحويصلات الهوائية أو أنسجة الرئة نفسها (مثل التهاب الرئة، التليف الكيسي والجمرة الخبيثة مثلاً) تتسبب في إعاقة التبادل الغازي، مما يقلل من قدرة الرئة على إشباع الدم بالأكسجين والتخلص من ثاني أكسيد الكربون، مما يدعو إلى زيادة وتيرة التنفس للتعويض عن هذا النقص، الأمر الذي يسبب إرهاقاً للعضلات التنفسية. أما الأمراض التي تُتلف الرئة مثل السرطانات فهي تقلل من حجم الرئة المُتاح للتنفس، فيضطر الجسم لزيادة وتيرة التنفس للتعويض مما يسبب شعوراً بضيق النفس. من أمراض الرئة المسببة لضيق النفس:
الرَّبو.
التهاب القصبات الحاد (بالإنجليزية: Bronchitis).
الداء الرئوي المُسِد المُزمن (بالإنجليزية: Chronic obstructive lung disease).
التليف الكيسي (بالإنجليزية: Cystic fibrosis).
النُّفاخ الرئوي (بالإنجليزية: Emphysema).
ذات الرئة (التهاب الرئة). (بالإنجليزية: Pneumonia)
استرواح الصدر (بالإنجليزية: Pneumothorax).
انصباب جنبي (بالإنجليزية: Pleural effusion).
الجمرة الخبيثة.
انخماص (بالإنجليزية: Atelectasis).
سرطان الرئة.
وذمة الرئة (بالإنجليزية: Pulmonary edema).
أمراض الدوران الرئوي
انصمام رئوي (بالإنجليزية: Pulmonary embolism).
فرط ضغط الدم الرئوي (بالإنجليزية: Pulmonary hypertension)
أمراض المجاري التنفسية
التضيقات التي تصيب المجاري التنفسية قبل وصولها إلى الرئة تؤدي إلى ضيق النفس والشعور بالاختناق، ومن هذه الحالات ما يحدث عند الأطفال عند التشردق (دخول جسم غريب إلى القصبة الهوائية)، وكذلك ما يحدث عند التهاب لسان المزمار أو التهاب البلعوم، ومن الأمثلة على ذلك:
التشردق وبخاصة لأجسام غريبة وبخاصة عند الأطفال.
التهاب لسان المزمار (بالإنجليزية: Epigottitis).
التهاب البلعوم (بالإنجليزية: Pharyngitis).
التهاب الحنجرة (بالإنجليزية: Laryngitis).
التورم الدرقي (بالإنجليزية: Struma).
سرطان الحنجرة وسرطان البلعوم.
تليُّن الرغامي أو تليُّن القصبة الهوائية (بالإنجليزية: Tracheomalacia).
أمراض القلب
تسبب أمراض القلب في عجز القلب عن نقل الدم من الرئة إلى باقي الجسم بالسرعة الكافية، مما يؤدي إلى احتقان السوائل قبل البطين الأيسر، وبالتالي خروج السوائل من الأوعية الدموية إلى الحويصلات الهوائية وبالتالي إعاقة تبادل الغازات. ومن أمراض القلب المؤدية لضيق النفس:
قصور القلب.
اعتلال عضلة القلب.
اعتلالات صمامات القلب.
داء شريان القلب التاجي.
احتشاء عضل القلب.
اندحاس قلبي (بالإنجليزية: Cardiac tamponade).
انصباب تاموري (بالإنجليزية: Pericardial effusion).
التهاب التامور (بالإنجليزية: Pericarditis).
اختلالات الدم والاستقلاب
فقر الدم يؤدي لنقص الكريات الحمراء الحاملة للأكسجين في الدم.
فشل كلوي يسبب ضيق النفس من خلال التأثير على حموضة الدم، فتضطر الرئة لرفع وتيرة التنفس للتخلص من كمية أكبر من ثاني أكسيد الكربون لتعديل حموضة الدم. ومن ناحية أخرى قد يؤدي قصور الكلى إلى تراكم السوائل في الجسم وبالتالي إلى وذمة الرئة.
قصور الكظر (بالإنجليزية: Adrenal insufficiency).
إنتان (بالإنجليزية: Sepsis) من خلال الإضرار بوظيفة الرئتين.
ابيضاض الدم (بالإنجليزية: Leukemia).
قصور الدرقية (بالإنجليزية: Hypothyroidism).
اختلالات عضلية وعصبية
جميع الأمراض التي تؤدي إلى ضعف عام بالجهاز العضلي والعضلي، تؤدي إلى ضعف عضلات التنفس أيضاً، وبالتالي إرهاق هذه العضلات والشعور بضيق النفس. الضعف الشديد لعضلات التنفس يؤدي - إذا لم يتم علاجه أو التعويض عنه بالتنفس الصناعي - إلى الاختناق والموت كما كان يحدث في شلل الأطفال أو الكزاز. من الأمراض العضلية والعصبية التي تؤثر على الجهاز التنفسي وتسبب ضيق النفس:
تصلب متعدد (بالإنجليزية: Multiple sclerosis).
وَهَن عَضَلي وَبيل (بالإنجليزية: Myasthenia gravis).
متلازمة غيلان باريه (بالإنجليزية: Guillain-Barré syndrome).
متلازمة لامبرت-إيتون (بالإنجليزية: Lambert-Eaton myasthenic syndrome).
شلل الأطفال (بالإنجليزية: Poliomyelitis).
التصلب العضلى الجانبي (بالإنجليزية: Amyotrophic lateral sclerosis).
الكزاز (بالإنجليزية: Tetanus).
داء الإعياء المزمن (بالإنجليزية: Chronic fatigue syndrome).
إعاقات الحجاب الحاجز
حركة الحجاب الحاجز. شلل الحجاب الحاجز: في بعض الحالات فإن حركة الحجاب الحاجز تتم إعاقتها، وبالتالي إعاقة أهم عضلة تنفسية، يحدث هذا عند شلل الحجاب الحاجز نتيجة إضرار العصب الحجابي مثلاً؛ كمضاعفة أثناء عمليات جراحة الصدر أو كمضاعفة أثناء عملية إزالة التورم الدرقي وقطع العصب بالخطأ. شلل الحجاب الحاجز يكون إما لجانب واحد (الأيمن أو الأيسر)، ونادراً ما يشمل جانبي الحجاب الحاجز.
السُّمنة أو فرط الوزن الزائد، حيث يُعيق الوزن الزائد للبطن حركة الحجاب الحاجز.
الحمل: قد يتسبب الحمل في زيادة العبء على الحجاب الحاجز، مما يؤدي لإعاقة حركته.
اضطرابات نفسية
في كثير من حالات القلق النفسي والخوف والرُّهاب يرافق الحالة العصبية شعور بضيق نفس "غير عُضوي" يُدعى أحياناً بضيق النفس الوظيفي (بالإنجليزية: Functional dyspnea)، حيث يكون ضيق النفس في هذه الحالات علامةً على الاضطراب النفسي، وقد يرافقه زيادة غير مبررة في وتيرة التنفس، وهو ما يُدعى بمتلازمة فرط التهوية (بالإنجليزية: Hyperventilation syndrome). التفريق بين "ضيق النفس الوظيفي" و"ضيق النفس العضوي" صعب، إذ أن ضيق النفس الوظيفي يرافقه أيضاً التعرق، زيادة وتيرة التنفس، والشكوى من ضيق النفس.
علاج ضيق النفس
قناع الأكسجين لعلاج ضيق النفس. لعلاج ضيق النفس لابد من معرفة السبب الكامن وراء ضيق النفس وإزالته، وهذا أمرٌ مهم، إذ أن العديد من الأمراض المسببة لضيق النفس تشكل خطراً على حياةً المريض مثل الجلطة القلبية، أو الالتهابات الرئوية، ومنها ما يمكن علاجه على الفور مثل إزالة الجسم الغريب من المجاري التنفسية للأطفال، وبشكل عام يعتبر ضيق النفس عرضاً خطيراً يحتاج العلاج الفوري ويتطلب في كثير من الأحيان الإدخال الفوري للمستشفى.
رغم ذلك فإن علاج عَرَض ضيق النفس علاجاً عرضياً (أي بدون إزالة سببه) يكون ضرورياً في حالات عديدة، منها التخفيف عن المرضى عناء ضيق النفس في الأمراض التي تحتاج وقتاً لعلاجها (مثل علاج التهابات الرئة التي تحتاج إلى أيام لحين السيطرة عليها)، أو في الحالات التي لا يكون الطب قادراً على علاجها (مثل السرطانات المتقدمة)، فيكون الهدف من علاج ضيق النفس التخفيف من معاناة المريض وتلطيف مراحله الأخيرة (علاج تلطيفي (بالإنجليزية: Palliative Therapy)).
يهدف علاج ضيق النفس إلى التقليل من العبء التنفسي من خلال مساندة عضلات التنفس، والتخفيف من المجهود المبذول في ذلك، ورفع مستوى الأكسجين في الدم من خلال رفع نسبة الأكسجين في الهواء المستنشق (باستخدام أقنعة الأكسجين). يُفيد العلاج بالأكسجين أيضاً في تحسين تروية الأعضاء والتقليل من الضرر الناجم عن اختلال آلية التنفس.
في الحالات الحرجة فإن التغلب على ضيق النفس والقصور الرئوي يتطلب التنفس الاصطناعي باستخدام ماكينات التنفس الصناعي، والتي تقوم بتولي وظيفة "تهوية" الرئة بشكلٍ جزئيٍ أو كامل بحسب الحاجة.
أما تخفيف الخوف الناجم عن ضيق النفس، والتقليل من معاناة المرضى فيمكن تحقيقه باستخدام المورفين[4]، والذي يعمل على تهدئة المريض، والتقليل من نقل إشارات ضيق النفس إلى الدماغ، ومن ثم التقليل من الوعي بالخطر والتخفيف عن المريض، كما تساهم مشتقات البينزوديازيبين في تهدئة المرضى والتخفيف عليهم. بالإضافة إلى تهدئة المرضى فإن هذه المشتقات تساهم في توفير طاقة المريض ومساعدته على التنفس بهدوء أكثر.
علم الأوبئة
ضيق النفس هو السبب الرئيسي ل3.5% من الأشخاص الذين يحضرون إلى قسم الطوارىء في الولايات المتحدة. من هذا العدد، حوالي 51% يدخلون إلى المستشفى و13% يموتون خلال سنة.[5] اقترحت بعض الدراسات أن حوالي 27% من الناس يعانون من ضيق النفس في حين أن عند الموت 75% يختبرونه.[6]
المراجع
↑ أ ب Harrison's Principles of Internal Medicine; 15th Edition, Page: 199ff. ISBN 0-07-118319-1 
^ Basislehrbuch Innere Medizin. H-Polster, Krautzig & Braun; 3. Auflage. SS 423. ISBN 978-3-437-41052-9 
↑ أ ب Differenzialdiagnose Innere Medizin. A.Sturm u. W. Zidek; Thieme-Verlag.2003 ISBN 3-13-116921-4
↑ أ ب Dyspnea from The Merck Manuals (بحسب عرض 28.3.2010)
^ ^ Stephen J. Dubner; Steven D. Levitt (2009). SuperFreakonomics: Tales of Altruism, Terrorism, and Poorly Paid Prostitutes. New York: William Morrow. pp. 77. ISBN 0-06-088957-8.
^ ^ Murray and Nadel's Textbook of Respiratory Medicine, 4th Ed. Robert J. Mason, John F. Murray, Jay A. Nadel, 2005, Elsevier
--------------------------------------------------------------------------------------------------------------------------------
العرض باللغة الانجليزية
Dyspnea
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Dyspnea ICD-10 R06.0 ICD-9 786.09 DiseasesDB 15892 MedlinePlus 003075 MeSH D004417
Dyspnea (pron.: /dɪspˈniːə/ disp-NEE-ə; also dyspnoea; Latin: dyspnoea; Greek: δύσπνοια, dýspnoia), shortness of breath (SOB), or air hunger,[1] is the subjective symptom of breathlessness.[2][3]
It is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations.[2] In 85% of cases it is due to either asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or psychogenic causes.[4] Treatment typically depends on the underlying cause.[5]
Contents
1 Definition
2 Differential diagnosis
2.1 Acute coronary syndrome
2.2 Congestive heart failure
2.3 Chronic obstructive pulmonary disease
2.4 Asthma
2.5 Pneumothorax
2.6 Pneumonia
2.7 Pulmonary embolism
2.8 Anaemia
2.9 Other
3 Pathophysiology
4 Evaluation
4.1 Blood tests
4.2 Imaging
5 Treatment
6 Physiotherapy
6.1 Palliative
7 Epidemiology
8 Etymology
9 See also
10 References
11 External links
Definition
The American Thoracic Society defines dyspnea as: "A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity."[6] Other definitions describe it as "difficulty in breathing",[7] "disordered or inadequate breathing",[8] "uncomfortable awareness of breathing",[3] and as the experience of "breathlessness" (which may be either acute or chronic).[2][5][9]
Dyspnea is distinct from labored breathing, which is a common physical presentation of respiratory distress.[citation needed]
Differential diagnosis
Further information: List of causes of shortness of breath
While shortness of breath is generally caused by disorders of the cardiac or respiratory system, other systems such as neurological,[10] musculoskeletal, endocrine, hematologic, and psychiatric may be the cause.[4] DiagnosisPro, an online medical expert system, listed 497 distinct causes in October 2010.[11] The most common cardiovascular causes are acute myocardial infarction and congestive heart failure while common pulmonary causes include chronic obstructive pulmonary disease, asthma, pneumothorax,pulmonary edema and pneumonia.[2] On a pathophysiological basis the causes can be divided into: (1) an increased awareness of normal breathing such as during an anxiety attack, (2) an increase in the work of breathing and (3) an abnormality in the ventilatory system.[10]
Acute coronary syndrome
Acute coronary syndrome frequently presents with retrosternal chest discomfort and difficulty catching the breath.[2] It however may atypically present with shortness of breath alone.[12] Risk factors include old age, smoking, hypertension, hyperlipidemia, and diabetes.[12] An electrocardiogram and cardiac enzymes are important both for diagnosis and directing treatment.[12] Treatment involves measures to decrease the oxygen requirement of the heart and efforts to increase blood flow.[2]
Congestive heart failure
Congestive heart failure frequently presents with shortness of breath with exertion, orthopnea, and paroxysmal nocturnal dyspnea.[2] It affects between 1-2% of the general United States population and occurs in 10% of those over 65 years old.[2][12] Risk factors for acute decompensation include high dietary salt intake, medication noncompliance, cardiac ischemia, dysrhythmias, renal failure, pulmonary emboli, hypertension, and infections.[12] Treatment efforts are directed towards decreasing lung congestion.[2]
Chronic obstructive pulmonary disease
People with chronic obstructive pulmonary disease (COPD), most commonly emphysema or chronic bronchitis, frequently have chronic shortness of breath and a chronic productive cough.[2] An acute exacerbation presents with increased shortness of breath and sputum production.[2] COPD is a risk factor for pneumothorax; thus this condition should be ruled out.[2] In an acute exacerbation treatment is with a combination of anticholinergics, beta2-adrenoceptor agonists, steroids and possibly positive pressure ventilation.[2]
Asthma
Asthma is the most common reason for presenting to the emergency with shortness of breath.[2] It is the most common lung disease in both developing and developed countries affecting about 5% of the population.[2] Other symptoms include wheezing, tightness in the chest, and a non productive cough.[2] Inhaled corticosteroids are the preferred treatment for children, however these drugs can reduce the growth rate.[13] Acute symptoms are treated with short-acting bronchodilators.
Pneumothorax
Main article: Pneumothorax
Pneumothorax presents typically with pleuritic chest pain of acute onset and shortness of breath not improved with oxygen.[2] Physical findings may include absent breath sounds on one side of the chest, jugular venous distension, and tracheal deviation.[2]
Pneumonia
Main article: Pneumonia
The symptoms of pneumonia are fever, productive cough, shortness of breath, and pleuritic chest pain.[2] Inspiratory crackles may be heard on exam.[2] A chest x-ray can be useful to differential pneumonia from congestive heart failure.[2] As the cause is usually a bacterial infections antibiotics are typically used for treatment.[2]
Pulmonary embolism
Pulmonary embolism classically presents with an acute onset of shortness of breath.[2] Other presenting symptoms include pleuritic chest pain, cough, hemoptysis, and fever.[2] Risk factors include deep vein thrombosis, recent surgery, cancer, and previous thromboembolism.[2] It must always be considered in those with acute onset of shortness of breath owing to its high risk of mortality.[2] Diagnosis however may be difficult.[2] Treatment is typically with anticoagulants.[2]
Pulmonary Edema link to COPD, Asthma and Heart failure.
Anaemia
Anaemia caused by low hemoglobin levels is often a cause of dyspnea. Menstruation, particularly if excessive, can contribute to anaemia and to consequential dyspnea in women. Headaches are also a symptom of dyspnea in patients suffering from anaemia, some patients report a numb sensation in their head, and others have reported blurred vision caused by hypotension behind the eye due to a lack of oxygen and pressure, these patients have also reported severe head pain many of which lead to permanent brain damage, symptoms of this can be loss of concentration, focus, fatigue, language faculty impairment and memory loss.[citation needed]
Other
Other important or common causes of shortness of breath include cardiac tamponade, anaphylaxis, interstitial lung disease, panic attacks,[4][5][14] and pulmonary hypertension. Cardiac tamponade presents with dyspnea, tachycardia, elevated jugular venous pressure, and pulsus paradoxus.[14] The gold standard for diagnosis is ultrasound.[14] Anemia, that develops gradually, usually presents with exertional dyspnea, fatigue, weakness, and tachycardia.[14] It may lead to heart failure.[14] Anaphylaxis typically begins over a few minutes in a person with a previous history of the same.[5] Other symptoms include urticaria, throat swelling, and gastrointestinal upset.[5] The primary treatment is epinephrine.[5] Interstitial lung disease presents with gradual onset of shortness of breath typically with a history of a predisposing environmental exposure.[4] Shortness of breath is often the only symptom in those with tachydysrhythmias.[12] Panic attacks typically present with hyperventilation, sweating, and numbness.[5] They are however a diagnosis of exclusion.[4] Around 2/3 of women experience shortness of breath as a part of a normal pregnancy.[8] Neurological conditions such as spinal cord injury, phrenic nerve injuries, Guillain-Barre syndrome, amyotrophic lateral sclerosis, multiple sclerosis and muscular dystrophy can all cause an individual to experience shortness of breath.[10] A relatively unknown condition involving shortness of breath is empty nose syndrome.
Pathophysiology
Different physiological pathways may lead to shortness of breath including via chemoreceptors, mechanoreceptors, and lung receptors.[12]
It is thought that three main components contribute to dyspnea: afferent signals, efferent signals, and central information processing. It is believed the central processing in the brain compares the afferent and efferent signals; and dyspnea results when a "mismatch" occurs between the two: such as when the need for ventilation (afferent signaling) is not being met by physical breathing (efferent signaling).[15]
Afferent signals are sensory neuronal signals that ascend to the brain. Afferent neurons significant in dyspnea arise from a large number of sources including the carotid bodies, medulla, lungs, and chest wall. Chemoreceptors in the carotid bodies and medulla supply information regarding the blood gas levels of O2, CO2 and H+. In the lungs, juxtacapillary (J) receptors are sensitive to pulmonary interstitial edema, while stretch receptors signal bronchoconstriction. Muscle spindles in the chest wall signal the stretch and tension of the respiratory muscles. Thus, poor ventilation leading to hypercapnia, left heart failure leading to interstitial edema (impairing gas exchange), asthma causing bronchoconstriction (limiting airflow) and muscle fatigue leading to ineffective respiratory muscle action could all contribute to a feeling of dyspnea.[15]
Efferent signals are the motor neuronal signals descending to the respiratory muscles. The most important respiratory muscle is the diaphragm. Other respiratory muscles include the external and internal intercostal muscles, the abdominal muscles and the accessory breathing muscles.
As the brain receives its plentiful supply of afferent information relating to ventilation, it is able to compare it to the current level of respiration as determined by the efferent signals. If the level of respiration is inappropriate for the body's status then dyspnea might occur. There is also a psychological component to dyspnea, as some people may become aware of their breathing in such circumstances but not experience the distress typical of dyspnea.[15]
Evaluation
mMRC Breathlessness Scale Grade Degree of dyspnea
0 no dyspnea except with strenuous exercise
1 dyspnea when walking up an incline or hurrying on the level
2 walks slower than most on the level, or stops after 15 minutes of walking on the level
3 stops after a few minutes of walking on the level
4 with minimal activity such as getting dressed, too dyspneic to leave the house
The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination.[2] Signs that represent significant severity include hypotension, hypoxemia, tracheal deviation, altered mental status, unstable dysrhythmia, stridor, intercostal indrawing, cyanosis, and absent breath sounds.[4]
A number of scales may be used to quantify the degree of shortness of breath.[16] It may be subjectively rated on a scale from 1 to 10 with descriptors associated with the number (The Modified Borg Scale).[16] Alternatively a scale such as the MRC Breathlessness Scale might be used - it suggests five different grades of dyspnea based on the circumstances in which it arises.[17]
Blood tests
A number of labs may be helpful in determining the cause of shortness of breath. D-dimer while useful to rule out a pulmonary embolism in those who are at low risk is not of much value if it is positive as it may be positive in a number of conditions that lead to shortness of breath.[12] A low level of brain natriuretic peptide is useful in ruling out congestive heart failure; however, a high level while supportive of the diagnosis could also be due to advanced age, renal failure, acute coronary syndrome, or a large pulmonary embolism.[12]
Imaging
A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia.[12] Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism.[12]
Treatment
In those who are not palliative the primary treatment of shortness of breath is directed at its underlying cause.[5] Extra oxygen is effective in those with hypoxia; however, this has no effect in those with normal blood oxygen saturations, even in those who are palliative.[3][18]
Physiotherapy
Individuals can benefit from a variety of physical therapy interventions.[19] Persons with neurological/neuromuscular abnormalities may have breathing difficulties due to weak or paralyzed intercostal, abdominal and/or other muscles needed for ventilation.[20] Some physical therapy interventions for this population include active assisted cough techniques,[21] volume augmentation such as breath stacking,[22] education about body position and ventilation patterns[23] and movement strategies to facilitate breathing.[22]
Palliative
Along with the measure above, systemic immediate release opioids are beneficial in reducing the symptom of shortness of breath due to both cancer and non cancer causes.[3][24] There is a lack of evidence to recommend midazolam, nebulised opioids, the use of gas mixtures, or cognitive-behavioral therapy.[25]
Epidemiology
Shortness of breath is the primary reason 3.5% of people present to the emergency department in the United States. Of these approximately 51% are admitted to hospital and 13% are dead within a year.[26] Some studies have suggested that up to 27% of people suffer from dyspnea,[27] while in dying patients 75% will experience it.[15] Acute shortness of breath is the most common reason people requiring palliative care visit an emergency department.[3]
Etymology
Dyspnea (pron.: /dɪspˈniːə/ disp-NEE-ə; from Latin dyspnoea, from Greek dyspnoia from dyspnoos) literally means disordered breathing.[4]
See also
List of terms of lung size and activity
Orthopnea
References
^ About.com Health's Disease and Condition content > Dyspnea By Deborah Leader. Updated August 05, 2008
^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac Shiber JR, Santana J (May 2006). "Dyspnea". Med. Clin. North Am. 90 (3): 453–79. doi:10.1016/j.mcna.2005.11.006. PMID 16473100.
^ a b c d e Schrijvers D, van Fraeyenhove F (2010). "Emergencies in palliative care". Cancer J 16 (5): 514–20. doi:10.1097/PPO.0b013e3181f28a8d. PMID 20890149.
^ a b c d e f g Sarkar S, Amelung PJ (September 2006). "Evaluation of the dyspneic patient in the office". Prim. Care 33 (3): 643–57. doi:10.1016/j.pop.2006.06.007. PMID 17088153.
^ a b c d e f g h Zuberi, T. et al. (2009). "Acute breathlessness in adults". InnovAiT 2 (5): 307–15. doi:10.1093/innovait/inp055.
^ American Heart Society (1999). "Dyspnea mechanisms, assessment, and management: a consensus statement". Am Rev Resp Crit Care Med 159: 321–340.
^ TheFreeDictionary, retrieved on Dec 12, 2009. Citing:The American Heritage Dictionary of the English Language, Fourth Edition by Houghton Mifflin Company. Updated in 2009.Ologies & -Isms. The Gale Group 2008
^ a b "UpToDate Inc.".
^ "dyspnea - General Practice Notebook".
^ a b c Frownfelter, Donna; Dean, Elizabeth (2006). "8". In Willy E. Hammon III. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 139.
^ http://en.diagnosispro.com/differential_diagnosis-for/poisoning-specific-agent-dyspnea/25103-154-100.html
^ a b c d e f g h i j k Torres M, Moayedi S (May 2007). "Evaluation of the acutely dyspneic elderly patient". Clin. Geriatr. Med. 23 (2): 307–25, vi. doi:10.1016/j.cger.2007.01.007. PMID 17462519.
^ "How Is Asthma Treated and Controlled?".
^ a b c d e Wills CP, Young M, White DW (February 2010). "Pitfalls in the evaluation of shortness of breath". Emerg. Med. Clin. North Am. 28 (1): 163–81, ix. doi:10.1016/j.emc.2009.09.011. PMID 19945605.
^ a b c d Harrison's Principles of Internal Medicine (Kasper DL, Fauci AS, Longo DL, et al (eds)) (16th ed.). New York: McGraw-Hill.
^ a b Saracino A (October 2007). "Review of dyspnoea quantification in the emergency department: is a rating scale for breathlessness suitable for use as an admission prediction tool?". Emerg Med Australas 19 (5): 394–404. doi:10.1111/j.1742-6723.2007.00999.x. PMID 17919211.
^ Stenton C (2008). "The MRC breathless scale". Occup Med 58 (3): 226–7. doi:10.1093/occmed/kqm162. PMID 18441368.
^ Abernethy AP, McDonald CF, Frith PA et al. (September 2010). "Effect of palliative oxygen versus medical (room) air in relieving breathlessness in patients with refractory dyspnea: a double-blind randomized controlled trial". Lancet 376 (9743): 784–93. doi:10.1016/S0140-6736(10)61115-4. PMC 2962424. PMID 20816546.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "8". In Willy E. Hammon III. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "22". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 368.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "22". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 368–371.
^ a b Frownfelter, Donna; Dean, Elizabeth (2006). "32". Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 569–581.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "23". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier.
^ Naqvi F, Cervo F, Fields S (August 2009). "Evidence-based review of interventions to improve palliation of pain, dyspnea, depression". Geriatrics 64 (8): 8–10, 12–4. PMID 20722311.
^ DiSalvo, WM.; Joyce, MM.; Tyson, LB.; Culkin, AE.; Mackay, K. (Apr 2008). "Putting evidence into practice: evidence-based interventions for cancer-related dyspnea" (PDF). Clin J Oncol Nurs 12 (2): 341–52. doi:10.1188/08.CJON.341-352. PMID 18390468.
^ Stephen J. Dubner; Steven D. Levitt (2009). SuperFreakonomics: Tales of Altruism, Terrorism, and Poorly Paid Prostitutes. New York: William Morrow. pp. 77. ISBN 0-06-088957-8.
^ Murray and Nadel's Textbook of Respiratory Medicine, 4th Ed. Robert J. Mason, John F. Murray, Jay A. Nadel, 2005, Elsevier
External links
Dyspnea at GPnotebook
Dyspnea
Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage
Epistaxis
Hemoptysis
Abnormalities
of breathing
Respiratory soundsStridorWheezeCracklesRhonchiHamman's sign ApneaDyspneaHyperventilation/HypoventilationHyperpnea/Tachypnea/Hypopnea/BradypneaOrthopnea/PlatypneaTrepopnea Biot's respirationCheyne–Stokes respirationKussmaul breathing HiccupMouth breathing/SnoringBreath holding
Other
Asphyxia
Cough
Pleurisy
Sputum
Respiratory arrest
Hypercapnia/Hypocapnia
Pectoriloquy: Whispered pectoriloquy
Egophony
Bronchophony
Pleural friction rub
Fremitus
Silhouette sign
Chest, general
Chest pain
Precordial catch syndrome
M: RES
anat (n, x, l, c)/phys/devp
noco (c, p)/cong/tumr, sysi/epon, injr
proc, drug (R1/2/3/5/6/7)
Categories:
Abnormal respiration
Symptoms and signs: Respiratory system
Dyspnea
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Dyspnea ICD-10 R06.0 ICD-9 786.09 DiseasesDB 15892 MedlinePlus 003075 MeSH D004417
Dyspnea (pron.: /dɪspˈniːə/ disp-NEE-ə; also dyspnoea; Latin: dyspnoea; Greek: δύσπνοια, dýspnoia), shortness of breath (SOB), or air hunger,[1] is the subjective symptom of breathlessness.[2][3]
It is a normal symptom of heavy exertion but becomes pathological if it occurs in unexpected situations.[2] In 85% of cases it is due to either asthma, pneumonia, cardiac ischemia, interstitial lung disease, congestive heart failure, chronic obstructive pulmonary disease, or psychogenic causes.[4] Treatment typically depends on the underlying cause.[5]
Contents
1 Definition
2 Differential diagnosis
2.1 Acute coronary syndrome
2.2 Congestive heart failure
2.3 Chronic obstructive pulmonary disease
2.4 Asthma
2.5 Pneumothorax
2.6 Pneumonia
2.7 Pulmonary embolism
2.8 Anaemia
2.9 Other
3 Pathophysiology
4 Evaluation
4.1 Blood tests
4.2 Imaging
5 Treatment
6 Physiotherapy
6.1 Palliative
7 Epidemiology
8 Etymology
9 See also
10 References
11 External links
Definition
The American Thoracic Society defines dyspnea as: "A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity."[6] Other definitions describe it as "difficulty in breathing",[7] "disordered or inadequate breathing",[8] "uncomfortable awareness of breathing",[3] and as the experience of "breathlessness" (which may be either acute or chronic).[2][5][9]
Dyspnea is distinct from labored breathing, which is a common physical presentation of respiratory distress.[citation needed]
Differential diagnosis
Further information: List of causes of shortness of breath
While shortness of breath is generally caused by disorders of the cardiac or respiratory system, other systems such as neurological,[10] musculoskeletal, endocrine, hematologic, and psychiatric may be the cause.[4] DiagnosisPro, an online medical expert system, listed 497 distinct causes in October 2010.[11] The most common cardiovascular causes are acute myocardial infarction and congestive heart failure while common pulmonary causes include chronic obstructive pulmonary disease, asthma, pneumothorax,pulmonary edema and pneumonia.[2] On a pathophysiological basis the causes can be divided into: (1) an increased awareness of normal breathing such as during an anxiety attack, (2) an increase in the work of breathing and (3) an abnormality in the ventilatory system.[10]
Acute coronary syndrome
Acute coronary syndrome frequently presents with retrosternal chest discomfort and difficulty catching the breath.[2] It however may atypically present with shortness of breath alone.[12] Risk factors include old age, smoking, hypertension, hyperlipidemia, and diabetes.[12] An electrocardiogram and cardiac enzymes are important both for diagnosis and directing treatment.[12] Treatment involves measures to decrease the oxygen requirement of the heart and efforts to increase blood flow.[2]
Congestive heart failure
Congestive heart failure frequently presents with shortness of breath with exertion, orthopnea, and paroxysmal nocturnal dyspnea.[2] It affects between 1-2% of the general United States population and occurs in 10% of those over 65 years old.[2][12] Risk factors for acute decompensation include high dietary salt intake, medication noncompliance, cardiac ischemia, dysrhythmias, renal failure, pulmonary emboli, hypertension, and infections.[12] Treatment efforts are directed towards decreasing lung congestion.[2]
Chronic obstructive pulmonary disease
People with chronic obstructive pulmonary disease (COPD), most commonly emphysema or chronic bronchitis, frequently have chronic shortness of breath and a chronic productive cough.[2] An acute exacerbation presents with increased shortness of breath and sputum production.[2] COPD is a risk factor for pneumothorax; thus this condition should be ruled out.[2] In an acute exacerbation treatment is with a combination of anticholinergics, beta2-adrenoceptor agonists, steroids and possibly positive pressure ventilation.[2]
Asthma
Asthma is the most common reason for presenting to the emergency with shortness of breath.[2] It is the most common lung disease in both developing and developed countries affecting about 5% of the population.[2] Other symptoms include wheezing, tightness in the chest, and a non productive cough.[2] Inhaled corticosteroids are the preferred treatment for children, however these drugs can reduce the growth rate.[13] Acute symptoms are treated with short-acting bronchodilators.
Pneumothorax
Main article: Pneumothorax
Pneumothorax presents typically with pleuritic chest pain of acute onset and shortness of breath not improved with oxygen.[2] Physical findings may include absent breath sounds on one side of the chest, jugular venous distension, and tracheal deviation.[2]
Pneumonia
Main article: Pneumonia
The symptoms of pneumonia are fever, productive cough, shortness of breath, and pleuritic chest pain.[2] Inspiratory crackles may be heard on exam.[2] A chest x-ray can be useful to differential pneumonia from congestive heart failure.[2] As the cause is usually a bacterial infections antibiotics are typically used for treatment.[2]
Pulmonary embolism
Pulmonary embolism classically presents with an acute onset of shortness of breath.[2] Other presenting symptoms include pleuritic chest pain, cough, hemoptysis, and fever.[2] Risk factors include deep vein thrombosis, recent surgery, cancer, and previous thromboembolism.[2] It must always be considered in those with acute onset of shortness of breath owing to its high risk of mortality.[2] Diagnosis however may be difficult.[2] Treatment is typically with anticoagulants.[2]
Pulmonary Edema link to COPD, Asthma and Heart failure.
Anaemia
Anaemia caused by low hemoglobin levels is often a cause of dyspnea. Menstruation, particularly if excessive, can contribute to anaemia and to consequential dyspnea in women. Headaches are also a symptom of dyspnea in patients suffering from anaemia, some patients report a numb sensation in their head, and others have reported blurred vision caused by hypotension behind the eye due to a lack of oxygen and pressure, these patients have also reported severe head pain many of which lead to permanent brain damage, symptoms of this can be loss of concentration, focus, fatigue, language faculty impairment and memory loss.[citation needed]
Other
Other important or common causes of shortness of breath include cardiac tamponade, anaphylaxis, interstitial lung disease, panic attacks,[4][5][14] and pulmonary hypertension. Cardiac tamponade presents with dyspnea, tachycardia, elevated jugular venous pressure, and pulsus paradoxus.[14] The gold standard for diagnosis is ultrasound.[14] Anemia, that develops gradually, usually presents with exertional dyspnea, fatigue, weakness, and tachycardia.[14] It may lead to heart failure.[14] Anaphylaxis typically begins over a few minutes in a person with a previous history of the same.[5] Other symptoms include urticaria, throat swelling, and gastrointestinal upset.[5] The primary treatment is epinephrine.[5] Interstitial lung disease presents with gradual onset of shortness of breath typically with a history of a predisposing environmental exposure.[4] Shortness of breath is often the only symptom in those with tachydysrhythmias.[12] Panic attacks typically present with hyperventilation, sweating, and numbness.[5] They are however a diagnosis of exclusion.[4] Around 2/3 of women experience shortness of breath as a part of a normal pregnancy.[8] Neurological conditions such as spinal cord injury, phrenic nerve injuries, Guillain-Barre syndrome, amyotrophic lateral sclerosis, multiple sclerosis and muscular dystrophy can all cause an individual to experience shortness of breath.[10] A relatively unknown condition involving shortness of breath is empty nose syndrome.
Pathophysiology
Different physiological pathways may lead to shortness of breath including via chemoreceptors, mechanoreceptors, and lung receptors.[12]
It is thought that three main components contribute to dyspnea: afferent signals, efferent signals, and central information processing. It is believed the central processing in the brain compares the afferent and efferent signals; and dyspnea results when a "mismatch" occurs between the two: such as when the need for ventilation (afferent signaling) is not being met by physical breathing (efferent signaling).[15]
Afferent signals are sensory neuronal signals that ascend to the brain. Afferent neurons significant in dyspnea arise from a large number of sources including the carotid bodies, medulla, lungs, and chest wall. Chemoreceptors in the carotid bodies and medulla supply information regarding the blood gas levels of O2, CO2 and H+. In the lungs, juxtacapillary (J) receptors are sensitive to pulmonary interstitial edema, while stretch receptors signal bronchoconstriction. Muscle spindles in the chest wall signal the stretch and tension of the respiratory muscles. Thus, poor ventilation leading to hypercapnia, left heart failure leading to interstitial edema (impairing gas exchange), asthma causing bronchoconstriction (limiting airflow) and muscle fatigue leading to ineffective respiratory muscle action could all contribute to a feeling of dyspnea.[15]
Efferent signals are the motor neuronal signals descending to the respiratory muscles. The most important respiratory muscle is the diaphragm. Other respiratory muscles include the external and internal intercostal muscles, the abdominal muscles and the accessory breathing muscles.
As the brain receives its plentiful supply of afferent information relating to ventilation, it is able to compare it to the current level of respiration as determined by the efferent signals. If the level of respiration is inappropriate for the body's status then dyspnea might occur. There is also a psychological component to dyspnea, as some people may become aware of their breathing in such circumstances but not experience the distress typical of dyspnea.[15]
Evaluation
mMRC Breathlessness Scale Grade Degree of dyspnea
0 no dyspnea except with strenuous exercise
1 dyspnea when walking up an incline or hurrying on the level
2 walks slower than most on the level, or stops after 15 minutes of walking on the level
3 stops after a few minutes of walking on the level
4 with minimal activity such as getting dressed, too dyspneic to leave the house
The initial approach to evaluation begins by assessment of the airway, breathing, and circulation followed by a medical history and physical examination.[2] Signs that represent significant severity include hypotension, hypoxemia, tracheal deviation, altered mental status, unstable dysrhythmia, stridor, intercostal indrawing, cyanosis, and absent breath sounds.[4]
A number of scales may be used to quantify the degree of shortness of breath.[16] It may be subjectively rated on a scale from 1 to 10 with descriptors associated with the number (The Modified Borg Scale).[16] Alternatively a scale such as the MRC Breathlessness Scale might be used - it suggests five different grades of dyspnea based on the circumstances in which it arises.[17]
Blood tests
A number of labs may be helpful in determining the cause of shortness of breath. D-dimer while useful to rule out a pulmonary embolism in those who are at low risk is not of much value if it is positive as it may be positive in a number of conditions that lead to shortness of breath.[12] A low level of brain natriuretic peptide is useful in ruling out congestive heart failure; however, a high level while supportive of the diagnosis could also be due to advanced age, renal failure, acute coronary syndrome, or a large pulmonary embolism.[12]
Imaging
A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia.[12] Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism.[12]
Treatment
In those who are not palliative the primary treatment of shortness of breath is directed at its underlying cause.[5] Extra oxygen is effective in those with hypoxia; however, this has no effect in those with normal blood oxygen saturations, even in those who are palliative.[3][18]
Physiotherapy
Individuals can benefit from a variety of physical therapy interventions.[19] Persons with neurological/neuromuscular abnormalities may have breathing difficulties due to weak or paralyzed intercostal, abdominal and/or other muscles needed for ventilation.[20] Some physical therapy interventions for this population include active assisted cough techniques,[21] volume augmentation such as breath stacking,[22] education about body position and ventilation patterns[23] and movement strategies to facilitate breathing.[22]
Palliative
Along with the measure above, systemic immediate release opioids are beneficial in reducing the symptom of shortness of breath due to both cancer and non cancer causes.[3][24] There is a lack of evidence to recommend midazolam, nebulised opioids, the use of gas mixtures, or cognitive-behavioral therapy.[25]
Epidemiology
Shortness of breath is the primary reason 3.5% of people present to the emergency department in the United States. Of these approximately 51% are admitted to hospital and 13% are dead within a year.[26] Some studies have suggested that up to 27% of people suffer from dyspnea,[27] while in dying patients 75% will experience it.[15] Acute shortness of breath is the most common reason people requiring palliative care visit an emergency department.[3]
Etymology
Dyspnea (pron.: /dɪspˈniːə/ disp-NEE-ə; from Latin dyspnoea, from Greek dyspnoia from dyspnoos) literally means disordered breathing.[4]
See also
List of terms of lung size and activity
Orthopnea
References
^ About.com Health's Disease and Condition content > Dyspnea By Deborah Leader. Updated August 05, 2008
^ a b c d e f g h i j k l m n o p q r s t u v w x y z aa ab ac Shiber JR, Santana J (May 2006). "Dyspnea". Med. Clin. North Am. 90 (3): 453–79. doi:10.1016/j.mcna.2005.11.006. PMID 16473100.
^ a b c d e Schrijvers D, van Fraeyenhove F (2010). "Emergencies in palliative care". Cancer J 16 (5): 514–20. doi:10.1097/PPO.0b013e3181f28a8d. PMID 20890149.
^ a b c d e f g Sarkar S, Amelung PJ (September 2006). "Evaluation of the dyspneic patient in the office". Prim. Care 33 (3): 643–57. doi:10.1016/j.pop.2006.06.007. PMID 17088153.
^ a b c d e f g h Zuberi, T. et al. (2009). "Acute breathlessness in adults". InnovAiT 2 (5): 307–15. doi:10.1093/innovait/inp055.
^ American Heart Society (1999). "Dyspnea mechanisms, assessment, and management: a consensus statement". Am Rev Resp Crit Care Med 159: 321–340.
^ TheFreeDictionary, retrieved on Dec 12, 2009. Citing:The American Heritage Dictionary of the English Language, Fourth Edition by Houghton Mifflin Company. Updated in 2009.Ologies & -Isms. The Gale Group 2008
^ a b "UpToDate Inc.".
^ "dyspnea - General Practice Notebook".
^ a b c Frownfelter, Donna; Dean, Elizabeth (2006). "8". In Willy E. Hammon III. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 139.
^ http://en.diagnosispro.com/differential_diagnosis-for/poisoning-specific-agent-dyspnea/25103-154-100.html
^ a b c d e f g h i j k Torres M, Moayedi S (May 2007). "Evaluation of the acutely dyspneic elderly patient". Clin. Geriatr. Med. 23 (2): 307–25, vi. doi:10.1016/j.cger.2007.01.007. PMID 17462519.
^ "How Is Asthma Treated and Controlled?".
^ a b c d e Wills CP, Young M, White DW (February 2010). "Pitfalls in the evaluation of shortness of breath". Emerg. Med. Clin. North Am. 28 (1): 163–81, ix. doi:10.1016/j.emc.2009.09.011. PMID 19945605.
^ a b c d Harrison's Principles of Internal Medicine (Kasper DL, Fauci AS, Longo DL, et al (eds)) (16th ed.). New York: McGraw-Hill.
^ a b Saracino A (October 2007). "Review of dyspnoea quantification in the emergency department: is a rating scale for breathlessness suitable for use as an admission prediction tool?". Emerg Med Australas 19 (5): 394–404. doi:10.1111/j.1742-6723.2007.00999.x. PMID 17919211.
^ Stenton C (2008). "The MRC breathless scale". Occup Med 58 (3): 226–7. doi:10.1093/occmed/kqm162. PMID 18441368.
^ Abernethy AP, McDonald CF, Frith PA et al. (September 2010). "Effect of palliative oxygen versus medical (room) air in relieving breathlessness in patients with refractory dyspnea: a double-blind randomized controlled trial". Lancet 376 (9743): 784–93. doi:10.1016/S0140-6736(10)61115-4. PMC 2962424. PMID 20816546.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "8". In Willy E. Hammon III. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "22". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 368.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "22". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 368–371.
^ a b Frownfelter, Donna; Dean, Elizabeth (2006). "32". Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier. pp. 569–581.
^ Frownfelter, Donna; Dean, Elizabeth (2006). "23". In Donna Frownfelter and Mary Massery. Cardiovascular and Pulmonary Physical Therapy. 4. Mosby Elsevier.
^ Naqvi F, Cervo F, Fields S (August 2009). "Evidence-based review of interventions to improve palliation of pain, dyspnea, depression". Geriatrics 64 (8): 8–10, 12–4. PMID 20722311.
^ DiSalvo, WM.; Joyce, MM.; Tyson, LB.; Culkin, AE.; Mackay, K. (Apr 2008). "Putting evidence into practice: evidence-based interventions for cancer-related dyspnea" (PDF). Clin J Oncol Nurs 12 (2): 341–52. doi:10.1188/08.CJON.341-352. PMID 18390468.
^ Stephen J. Dubner; Steven D. Levitt (2009). SuperFreakonomics: Tales of Altruism, Terrorism, and Poorly Paid Prostitutes. New York: William Morrow. pp. 77. ISBN 0-06-088957-8.
^ Murray and Nadel's Textbook of Respiratory Medicine, 4th Ed. Robert J. Mason, John F. Murray, Jay A. Nadel, 2005, Elsevier
External links
Dyspnea at GPnotebook
Dyspnea
Symptoms and signs: respiratory system (R04–R07, 786)
Hemorrhage
Epistaxis
Hemoptysis
Abnormalities
of breathing
Respiratory soundsStridorWheezeCracklesRhonchiHamman's sign ApneaDyspneaHyperventilation/HypoventilationHyperpnea/Tachypnea/Hypopnea/BradypneaOrthopnea/PlatypneaTrepopnea Biot's respirationCheyne–Stokes respirationKussmaul breathing HiccupMouth breathing/SnoringBreath holding
Other
Asphyxia
Cough
Pleurisy
Sputum
Respiratory arrest
Hypercapnia/Hypocapnia
Pectoriloquy: Whispered pectoriloquy
Egophony
Bronchophony
Pleural friction rub
Fremitus
Silhouette sign
Chest, general
Chest pain
Precordial catch syndrome
M: RES
anat (n, x, l, c)/phys/devp
noco (c, p)/cong/tumr, sysi/epon, injr
proc, drug (R1/2/3/5/6/7)
Categories:
Abnormal respiration
Symptoms and signs: Respiratory system
