Clinical Breathlessness Overview

Clinical Breathlessness

• Breathlessness is a subjective feeling of difficulty breathing.
• It's not just a physical symptom but also affects thoughts and actions.
• People experience it differently; some may feel hot, panicky, or overwhelmed.
• Common feelings include chest tightness, the sensation of not getting enough air, and the feeling of needing but not able to take deep breaths.
• Breathlessness can be very distressing and often described as intense chest tightening, air hunger, or suffocation.

Causes of Breathlessness

• Lung Issues: Airways diseases (asthma, COPD), interstitial lung diseases (idiopathic pulmonary fibrosis), pulmonary embolism.
• Heart Issues: Heart conditions like ischemic heart disease, myocardial infarction, heart pump failure, chronic left ventricular impairment, arrhythmia (atrial fibrillation).
• Blood Problems: Blood loss, iron deficiency, chronic anemia (B12 and folate deficiencies), hemoglobinopathies (sickle cell disease).
• Head/Psychological Issues: Psychological causes like hyperventilation syndrome, neurodegenerative diseases (motor neuron disease).

History Taking for Breathlessness

• Presenting complaint, focusing on symptoms in the patient's own words.
• Complete history of the complaint.
• Explore each symptom and related symptoms.
• Compare symptoms to baseline, e.g., respiratory history.
• Evaluate factors such as smoking, occupation, and environment (e.g., birds/pets/farms).

Quantifying Breathlessness

• The MMRC Dyspnea Scale is used for grading breathlessness severity.
• The scale ranges from 0 (no breathlessness during strenuous exercise) to 4 (cannot leave the house or breathe while dressing).

The Magic Question

• A core question to determine breathlessness: "On a good day, on the flat, how far can you walk until you have to stop?"
• Try to quantify the distance.
• Beware of assumptions when considering the cause.

Other Symptoms

• Lungs: Cough, sputum, wheezing, pleuritic chest pain, haemoptysis, fevers, weight loss.
• Heart: Ischemic chest pain, palpitations, orthopnoea, paroxysmal nocturnal dyspnoea, ankle swelling.
• Blood: Bleeding, jaundice, malnutrition, weight loss, night sweats.
• Head: Anxiety, recent acute/chronic stressors, peripheral tingling, muscular weakness, swallowing/speech difficulties.

Diagnostic Guide

• Categorizing breathlessness based on its onset (seconds to days).
• Linking to common conditions (lung, heart, neurological).
• Considering factors for different conditions for further assessment (e.g., smoking, medications, occupational risks)
• Understanding time frames (instantaneous to weeks/months).

Case Examples

• Specific detailed cases are presented for Jeanie, Bobby, and Len, representing possible diagnoses or exacerbations of conditions like COPD and pulmonary edema. These cases highlight specific symptoms and important factors for a differential diagnosis.

Explore the multifaceted nature of clinical breathlessness, from its subjective experiences to its underlying causes. This quiz covers common lung and heart issues contributing to breathlessness and highlights the psychological aspects of the condition. Test your knowledge and understanding of this complex symptom.