Shortness of breath
Shortness of breath | |
---|---|
Other names | Dyspnea, dyspnoea, breathlessness, difficulty (in/of) breathing; respiratory distress |
Pronunciation |
|
Specialty | Pulmonology |
Shortness of breath (SOB), also medically known as dyspnea (in
Dyspnea is a normal
Definition
Dyspnea, in medical terms, is "shortness of breath". The American Thoracic Society defines dyspnea as: "A subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity."[7] Other definitions also describe it as "difficulty in breathing",[8] "disordered or inadequate breathing",[9] "uncomfortable awareness of breathing",[3] and as the experience of "breathlessness" (which may be either acute or chronic).[2][6][10]
Causes
While shortness of breath is generally caused by disorders of the
The tempo of onset and the duration of dyspnea are useful in knowing the etiology of dyspnea. Acute shortness of breath is usually connected with sudden physiological changes, such as
Acute coronary syndrome
COVID-19
People that have been infected by
Congestive heart failure
Chronic obstructive pulmonary disease
People with
Asthma
Pneumothorax
Pneumonia
The symptoms of
Pulmonary embolism
Anemia
Anemia that develops gradually usually presents with exertional dyspnea, fatigue, weakness, and tachycardia.[17] It may lead to heart failure.[17] Anaemia 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 with 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 pains, many of which lead to permanent brain damage. Symptoms can include loss of concentration, focus, fatigue, language faculty impairment and memory loss.[18][citation needed]
Cancer
Shortness of breath is common in people with cancer and may be caused by numerous different factors. In people with advanced cancer, periods of time with severe shortness of breath may occur, along with a more continuous feeling of breathlessness.[19] Treatments include both nonpharmacological and pharmacological interventions. Nonpharmacological interventions that showed improvement in breathlessness include fans, behavioral and pyschoeducational approaches, exercise and pulmonary rehabilitation. Integrative medicine options including acupuncture/acupressure/reflexology, meditation and music therapy were also used, with acupuncture/reflexology found to have a beneficial effect.[20]
Other
Other important or common causes of shortness of breath include cardiac tamponade, anaphylaxis, interstitial lung disease, panic attacks,[6][12][17] and pulmonary hypertension. Also, around 2/3 of women experience shortness of breath as a part of a normal pregnancy.[9]
Cardiac tamponade presents with dyspnea, tachycardia, elevated jugular venous pressure, and pulsus paradoxus.[17] The gold standard for diagnosis is ultrasound.[17]
Anaphylaxis typically begins over a few minutes in a person with a previous history of the same.
Interstitial lung disease presents with gradual onset of shortness of breath typically with a history of a predisposing environmental exposure.
Panic attacks typically present with hyperventilation, sweating, and numbness.[6] They are however a diagnosis of exclusion.[12]
Neurological conditions such as spinal cord injury, phrenic nerve injuries,
Sarcoidosis is an inflammatory disease of unknown etiology that generally presents with dry cough, fatigue, and shortness of breath, although multiple organ systems may be affected, with involvement of sites such as the eyes, the skin and the joints.[22]
Pathophysiology
Different physiological pathways may lead to shortness of breath including via ASIC chemoreceptors, mechanoreceptors, and lung receptors.[15]
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).[23]
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
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.[25]
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 typical distress of dyspnea.[23]
Diagnosis
Grade | Degree of dyspnea |
---|---|
1 | no dyspnea except with strenuous exercise |
2 | dyspnea when walking up an incline or hurrying on the level |
3 | walks slower than most on the level, or stops after 15 minutes of walking on the level |
4 | stops after a few minutes of walking on the level |
5 | with minimal activity such as getting dressed, too dyspneic to leave the house |
The initial approach to evaluation begins by assessment of the
A number of scales may be used to quantify the degree of shortness of breath.
Blood tests
A number of labs may be helpful in determining the cause of shortness of breath.
Imaging
A
Treatment
The primary treatment of shortness of breath is directed at its underlying cause.
Physiotherapy
Individuals can benefit from a variety of
Palliative medicine
Systemic immediate release
Non-pharmacological techniques
Pharmacological treatment
For people with severe, chronic, or uncontrollable breathlessness, non-pharmacological approaches to treating breathlessness may be combined with medication. For people who have cancer that is causing the breathlessness, medications that have been suggested include opioids, benzodiazepines, oxygen, and steroids.[19] Results of recent systematic reviews and meta-analyses found opioids were not necessarily associated with more effectiveness in treatment for patients with advanced cancer.[39][40]
Ensuring that the balance between side effects and adverse effects from medications and potential improvements from medications needs to be carefully considered before prescribing medication.[19] The use of systematic corticosteriods in palliative care for people with cancer is common, however the effectiveness and potential adverse effects of this approach in adults with cancer has not been well studied.[19]
Epidemiology
Shortness of breath is the primary reason 3.5% of people present to the
Etymology and pronunciation
English dyspnea comes from
In English, the various -pnea-suffixed words commonly used in medicine do not follow one clear pattern as to whether the /niː/ syllable or the one preceding it is stressed; the p is usually expressed but is sometimes silent depending on the word. The following collation or list shows the preponderance of how major dictionaries pronounce and transcribe them (less-used variants are omitted):
Group | Term | Combining forms | Preponderance of transcriptions (major dictionaries) |
---|---|---|---|
good | eupnea | eu- + -pnea | /juːpˈniːə/ yoop-NEE-ə[45][46][44][47] |
bad | dyspnea |
dys- + -pnea | /dɪspˈniːə/ disp-NEE-ə,[46][47][48] /ˈdɪspniə/ DISP-nee-ə[45][44] |
fast | tachypnea | tachy- + -pnea | /ˌtækɪpˈniːə/ TAK-ip-NEE-ə[45][46][44][47][48] |
slow | bradypnea | brady- + -pnea | /ˌbreɪdɪpˈniːə/ BRAY-dip-NEE-ə[46][44][47] |
upright | orthopnea | ortho- + -pnea | /ɔːrˈθɒpniə/ or-THOP-nee-ə,[46][44][48][45]: audio /ɔːrθəpˈniːə/ or-thəp-NEE-ə[44][45]: print |
supine | platypnea | platy- + -pnea | /pləˈtɪpniə/ plə-TIP-nee-ə[45][46] |
bent over | bendopnea | bend + -o- + -pnea | /bɛndˈɒpniə/ bend-OP-nee-ə |
excessive | hyperpnea | hyper- + -pnea | /ˌhaɪpərpˈniːə/ HY-pərp-NEE-ə[45][46][44][47] |
insufficient | hypopnea | hypo- + -pnea | /haɪˈpɒpniə/ hy-POP-nee-ə,[45][46][47][48] /ˌhaɪpəpˈniːə/ high-pəp-NEE-ə[44][47] |
absent | apnea | a- + -pnea | /ˈæpniə/ AP-nee-ə,[45][46][44][47][48]: US /æpˈniːə/ ap-NEE-ə[44][47][48]: UK |
See also
References
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