In typical cases, patients characterize shortness of breath as:
- difficulty breathing;
- a feeling of tightness in the chest and lack of air when inhaling;
- inability to take a deep breath and/or fully exhale.
Inspiratory dyspnea
Usually accompanied by the inclusion of auxiliary respiratory muscles in the act of breathing, which is also manifested in the form of retraction of the subclavian fossa, epigastric region, intercostal spaces, tension of the sternocleidomastoid muscle.
The most common type of shortness of breath is a mixed type, in which you can see swelling of the chest and retraction of the above areas.
Dyspnea in heart disease is inspiratory. It manifests itself as an inadequate (not corresponding to the state and conditions in which the patient is located) increased frequency and intensification of breathing: initially with minor physical activity, increasing sharply with significant physical effort, and then at rest, it can increase after eating, especially in a horizontal position, forcing patients sit (orthopnea). Such attacks are sometimes called “cardiac asthma,” and shortness of breath becomes mixed. In a typical case, the patient wakes up with a feeling of lack of air, sits up in bed or goes to the window to get some fresh air. After half an hour, the patient feels better, he goes to bed and can sleep until the morning or after 2-3 hours wake up again from a second attack. In its extreme degree, shortness of breath turns into suffocation.
Expiratory dyspnea
With expiratory shortness of breath, exhalation is slow, sometimes with a whistle; the chest almost does not take part in the act of breathing, as if being in a position of constant inhalation.
With bronchial obstruction or loss of elasticity of the lung tissue (for example, with chronic emphysema), expiratory shortness of breath occurs. A significant decrease in the respiratory surface of the lungs is manifested by mixed shortness of breath, which can be temporary or permanent. It is observed in pneumonia, pleurisy, severe emphysema, fibrosing alveolitis (at first it is inspiratory) and other pathological conditions of the lungs. With emphysema, some patients exhale with their lips closed (puff).
The appearance of a mechanical obstruction in the upper respiratory tract (larynx, trachea) complicates and slows down the passage of air into the alveoli and causes inspiratory dyspnea. With a sharp narrowing of the trachea and large bronchus, shortness of breath becomes mixed (not only inhalation, but also exhalation is difficult), breathing becomes noisy, audible at a distance (stridor breathing).
In diseases of the respiratory system, shortness of breath is usually both subjective and objective at the same time. With emphysema, shortness of breath is sometimes only objective; it is the same with obliteration of the pleura. With hysteria and thoracic radiculitis, it is only subjective.
Shortness of breath in the form of tachypnea is observed with pneumonia, bronchogenic cancer, and tuberculosis. With pleurisy, breathing becomes shallow and painful; with embolism or thrombosis of the pulmonary artery, sudden, often painful shortness of breath occurs with deep inhalation and exhalation, sometimes in a lying position.
And in pediatric practice, a clinically important criterion is the constant nature of shortness of breath. In this case, cystic fibrosis, congenital anomalies of the respiratory tract or heart, or foreign body aspiration may be suspected.
Characterized by a feeling of general discomfort due to insufficient oxygen saturation of the blood and tissues. Patients describe their sensations associated with shortness of breath in different ways – “not enough air”, “feeling of constriction in the chest, behind the sternum, in the throat”, “fatigue in the chest”, “I can’t breathe in completely”, “I’m gasping for air with my open mouth , “I breathe like a fish,” etc.
A very important clinical characteristic of shortness of breath is its relationship with physical activity. If in the initial stages of the disease shortness of breath occurs only with significant physical effort (for example, quickly climbing several floors of stairs), then in advanced stages it appears even with everyday simple actions (for example, tying shoelaces) and even at rest.
Shortness of breath can occur with chronic diseases of the respiratory system, accompanied by sputum production – in this case, shortness of breath is associated with the accumulation of sputum in the respiratory tract and after moving to a vertical position (the effect of postural drainage) and coughing it decreases.
Questions to ask a patient with shortness of breath:
- How long has the shortness of breath been present?
- Is shortness of breath constant or occurs from time to time?
- What causes or worsens shortness of breath?
- What is the severity of shortness of breath?
- How much does it limit physical activity?
- What relieves shortness of breath?
Treatment of shortness of breath