Dyspnea: Breathlessness and Respiratory Disorders

Definition and Types of Dyspnea

• Dyspnea is the subjective sensation of shortness of breath, which may be discomfort or an abnormal awareness of breathing.
• It is the most prominent symptom of pulmonary diseases, but can also be seen as a primary manifestation of nonpulmonary disorders, such as cardiac diseases.
• Types of dyspnea include:
  • Orthopnea
  • PND
  • Trepopnea
  • Platypnea
  • Exertional dyspnea

Causes of Dyspnea

Acute Dyspnea

• Cardiovascular causes: acute pulmonary oedema
• Respiratory causes:
  • Acute severe asthma
  • Acute exacerbation of chronic obstructive pulmonary disease (COPD)
  • Pulmonary embolism
  • Pneumonia
  • Pneumothorax
  • Acute respiratory distress syndrome (ARDS)
  • Lobar collapse
  • Laryngeal oedema (e.g. anaphylaxis)
  • Inhaled foreign body
• Other causes:
  • Psychogenic hyperventilation (e.g. anxiety)
  • Acidosis

Chronic Dyspnea

• Cardiovascular causes:
  • Chronic heart failure
  • Myocardial ischemia
• Respiratory causes:
  • COPD/asthma
  • Interstitial lung disease
  • Bronchogenic carcinoma
  • Chronic pulmonary thromboembolism
  • Large pleural effusion
• Other causes:
  • Severe anemia
  • Obesity

Approach to Patient with Dyspnea

Chronic Dyspnea

• The approach depends on careful history and clinical examination, ECG, CXR, and other lab and imaging techniques according to each case.
• Key questions to ask include:
  • How is your breathing at rest or during sleep time?
  • How much you can do on a good day? (exercise capacity)
  • Document the distant the patient can walk on the level.
  • Any breathing problem in childhood or at school? Any history of atopic allergy?
  • The presence of these will increase the likelihood of asthma.
• Symptoms to ask about include:
  • Cough (dry or productive)
  • Wheezing
  • Pleuritic chest pain, especially if it occurs in more than one site over time = chronic thromboembolic diseases.
  • Morning headache = CO2 retention

Acute Dyspnea

• Acute severe breathlessness is a medical emergency.
• History points to consider:
  • Rate of onset and severity of breathlessness
  • Associated cardiac symptoms: chest pain, palpitation, sweating, and nausea
  • Respiratory symptoms: cough, wheezing, haemoptysis
  • In children: consider inhalation of a foreign body or acute epiglottitis
• Clinical examination should assess and document:
  • Vital signs
  • Level of consciousness
  • Degree of central cyanosis
  • Patency of upper airways
  • Ability to speak (in single words or sentences)
  • Cardiovascular status examination
  • Respiratory examination
  • Leg swelling: bilateral or unilateral

Treatment of Acute Breathlessness

• Specific treatment is directed to the underlying cause.
• Endotracheal intubation should be considered in case of impairment of the level of consciousness or in the case of severe respiratory acidosis.

This quiz covers the definition, types, and causes of dyspnea, a subjective sensation of shortness of breath. Learn about the different forms of dyspnea and its relation to pulmonary and nonpulmonary diseases.