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What is Shortness of Breath or Dyspnoea?

It is the subjective sensation of difficulty in breathing. The patient complains of breathlessness.

The lungs and the heart are very intimately connected organs both physically and functionally. Breathlessness or dyspnoea stems from a dysfunction of primarily these two systems – cardiac and respiratory.

Diseases of the lung like asthma, pneumonia and other infections, COPD, bronchitis cause breathlessness where difficulty in breathing predominates. Conditions like heart failure have breathlessness associated with signs of failure in other organs as well.

Types

  • Respiratory system dyspnoea
  • Cardiovascular system dyspnoea
  • Orthopnoea: Breathlessness on lying down, made better by sitting up or using a higher pillow: generally due to heart disease
  • Platypnoea: Breathlessness on sitting up straight, relieved on lying down: in enlargement of liver. 

How common is Dyspnoea?

Dyspnoea is not a disease, but a symptom of an underlying disease. It is one of the very common complaints that elderly can complain of. Both heart disease and lung disease are fairly common in old age due to a lifetime varied exposure and wear and tear damage.

What are the causes and risk factors for Dyspnoea?

  • Respiratory Dyspnoea
    • Diseases of the airways
    • Diseases of the lung tissue
      • Infections
      • Lung fibrosis
      • Occupational exposure leading to interstitial disease
    • Diseases of the chest wall
      • Kyphosis
      • Scoliosis
      • Muscle paralysis
      • Pleural effusions (fluid in the pleural cavity – space around the lungs)
      • Coronary artery disease
      • Non ischemic cardiomyopathy
      • Left heart failure
    • Diseases  of pulmonary vasculature
      • Pulmonary thromboembolism
      • Pulmonary hypertension
      • Pulmonary vasculitis
    • Diseases of the pericardium (covering of the heart)
      • Constrictive pericarditis
      • Cardiac tamponade

What are the symptoms of Shortness of Breath?

Breathlessness may be associated with a variety of symptoms as per the underlying condition.

  • Chest pain
  • Air hunger
  • Constricting sensation in the chest
  • Swelling on feet
  • Puffiness of face
  • Bluish discoloration of lips and nose tip

How is Shortness of Breath diagnosed?

Dyspnoea doesn’t need to be diagnosed. It is a complaint, a symptom that the patient presents with. The cause of the dyspnoea needs to be investigated which is achieved through a detailed history and thorough examination of both the respiratory and cardiovascular systems along with the chest wall.

The following investigations may be advised to look for abnormalities in the respiratory and cardiovascular systems.

  • Chest X-ray
  • ECG
  • 2D Echo
  • Ultrasonography of abdomen
  • Lung function test
  • Blood investigations
  • Arterial blood gases

What is the treatment for Shortness of Breath?

Once the cause is diagnosed, appropriate treatment is given. A postural adjustment may be necessary to reduce the effort of breathing to a minimum.

What are the complications with Dyspnoea?

Complications correspond to the respective diseases. Breathlessness is a very distressing symptom, far more uncomfortable than pain. It instills a fear of doom and death into the patient. It surely suggests that the oxygen demand is not being met. If it progresses rapidly, person may require artificial ventilation to meet the oxygen demand.

Unless corrected promptly, the patient rapidly deteriorates.

What lifestyle changes are recommended to prevent Dyspnoea?

  • After the initial symptoms are resolved, regular exercise to the extent tolerable may help in increasing the lung capacity.
  • In case of asthma, abstinence of exposure to the allergen is an effective way of preventing future episodes.
  • Quit smoking.

How to take care of someone with Dyspnoea? (Advice to the caregiver)

  • Once breathlessness sets in, allow the patient to take the position that is most comfortable to them.
  • In case of chronic diagnoses, the supportive apparatus like inhalers and masks should be kept ready to use in case a sudden episode of breathlessness be triggered.

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