Clinical Breathlessness PDF

Clinical breathlessness Learning outcomes: What is breathlessness? Why do people get breathless? How can we help breathless people? Breathlessness is a subjective, distressing sensation of awareness of difficulty...

Clinical breathlessness Learning outcomes: What is breathlessness? Why do people get breathless? How can we help breathless people? Breathlessness is a subjective, distressing sensation of awareness of difficulty with breathing Feeling Breathless Breathlessness is not only a physical symptom. It’s also a feeling that affects the way we think and act. We each feel it differently You may feel hot, panicky or overwhelmed Your chest might feel so tight it feels like the breath cannot get in You might feel you’re suffocating or not being able to get enough air and you feel you need to take deep breaths but can’t You might feel breathing is very hard work, and exhausting Few sensations are as frightening as not being able to get enough air. Shortness of breath — known medically as dyspnea — is often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation. Causes of breathlessness: Lung stuff Airways diseases: asthma, COPD Interstitial Lung diseases: Idiopathic Pulmonary Fibrosis Pulmonary embolism Heart Stuff Clinical breathlessness 1  Ischaemic Heart Disease: Myocardial infarction Heart Pump Failure: Chronic Left Ventricular Impairment Arrhythmia: Atrial Fibrillation Blood Stuff Blood loss: Fe deficiency Chronic anaemia: B12 + Folate deficiency Haemoglobinopathies: Sickle Cell Disease Head Stuff Psychological causes: Hyperventilation Syndrome Neurodegenerative Diseases: Motor Neurone Disease We can treat a person’s breathlessness by TREATING THE CAUSE How do we find the cause of a person’s breathlessness? History taking is the most important skill in clinical medicine It is also the most challenging Overview of history taking Presenting complaint - Symptoms Person’s own words / few symptoms History of presenting complaint - Context Explore each offered symptom Explore all the other related symptoms Compare both the symptoms to baseline eg Respiratory Hx Smoking Occupation Birds / Pets / Farms Clinical breathlessness 2  Past medical history Drug history Family history Social history Systemic Questions List of symptoms Onset Duration Pattern Severity (quantify) Triggers Relievers Current versus Baseline Associated features How can we quantify breathlessness? Clinical breathlessness 3  What other symptoms guide us to the cause of breathlessness? Clinical breathlessness 4 Clinical breathlessness 5 Clinical breathlessness 6  Exacerbation of COPD Clinical breathlessness 7  Acute Pulmonary Oedema Clinical breathlessness 8  Anaemia / Blood Loss Blood transfusion may be required to treat this Clinical breathlessness 9