When faced with conditions concerning the respiratory system, often times, difficulty in breathing is experienced. This problem can lead to another problem so proper diagnosis and treatment is needed to solve the problem.
What is Dyspnea ?
Dyspnea comes from the Latin word ‘dyspnoea’ which means shortness of breath. It is associated with diseases in the respiratory and cardiovascular system. Normally, our body regulates our breathing via the medulla oblongata in the brainstem. Dyspnea is also experienced when resting or exerting an effort especially when doing an activity. Dyspnea is also classified into chronic and acute. Chronic dyspnea is when the difficulty in breathing lasts for a month or more while acute dyspnea is a month or less.
There are a number of reasons why dyspnea occurs. It can be due to a heart problem, lung problem or psychogenic causes, take a look at our 6-Ps of Dyspnea graphic below:
- Pericardial effusion or the accumulation of liquid in the heart
- Irregular heart rhythm
- Heart attack
- Heart failure (left sided or right sided heart failure)
- Pleural effusion or the accumulation of fluid in the pleural space
- Chronic obstructive pulmonary disease such as asthma, chronic bronchitis
- Pneumothorax caused by tumor and trauma (car accident, gunshot wound)
- Upper respiratory tract infection caused by bacteria or virus
- Cancer in the respiratory tract which constricts the lungs or the trachea and other respiratory organs
- Anxiety or panic attacks can cause breathing difficulties.
- Irregular breathing patterns
- Allergies (can be from the environment)
Degree of Dyspnea
There is a scale that measures the degree of dypsnea which is called the MRC breathlessness scale to know the level of difficulty in breathing the patient experiences. This is used to prioritize the treatment.
Grades of Dyspnea
Grade 1 : No dyspnea except in exhausting activities.
Grade 2 : Difficulty in breathing is felt when walking up in a slope or on the stairs
Grade 3 : Stops after 15 minutes of walking and the rate of walking is slow
Grade 4 : Stops in less than 15 minutes of walking
Grade 5 : Dyspnea is felt after doing something such as dressing up or minimal movements
Dyspnea Signs and Symptoms
Dyspnea is usually felt by when there is an underlying condition. Dyspnea is often felt when the airway passage is constricted thus air is not adequate to meet the demands of the system. Apart from dyspnea, a person may feel weakness or body malaise. Compensatory mechanisms such as increase in heart rate (tachycardia), restlessness, cyanosis or bluish discoloration of the skin and the nails because of the lack of oxygen in the body. Accessory muscles are also used such as the sternocleidomastoid, scalene muscles, the trapezius and others. Upon auscultation, abnormal breath sounds are heard such as wheezing. This is usually heard when the patient has asthma.
Pathophysiology of Dyspnea
Since dyspnea is often connected with an underlying condition, there are numerous ways that will lead to difficulty in breathing. Perhaps, one of the reasons why dyspnea occurs is because of the three components that affect to the problem: the afferent and efferent signals, and the central information processing. The afferent signal is responsible in sending signals to the brain that there is inadequate supply oxygen in the body. These signals are gathered from the medulla, lungs and chest wall. Signals such as low oxygen, and carbon dioxide are sent to the brain. The efferent signals are then disseminated to the respiratory muscles such as the diaphragm as well as the accessory muscles for breathing.
Dyspnea at Rest
Sometimes, dyspnea even happens when resting. This can be traced to a condition called heart failure. There are 2 kinds of heart failure which is the right side and left side failure. Both conditions suffer from dyspnea however, in the right-sided heart failure, dyspnea at rest can happen. A condition which is also called as unstable angina wherein even at rest, pain can happen. Another sign that the angina happens is because there is difficulty in breathing even at rest.
Dyspnea on Exertion
By definition, dyspnea on exertion happens when a person is putting an effort when doing something such as walking, running or exercising. In children with heart conditions called the Tetralogy of Fallot, sometimes while the patient is exerting effort such as when playing or running, dyspnea will occur. Even in healthy individuals when putting much effort will also experience dyspnea because the body will need oxygen due to the energy loss.
Dyspnea after Eating
As mentioned, not all the time dyspnea is connected with an underlying condition. Dyspnea also happens after eating. When too much food is ingested, the stomach expands and the lungs are pushed upward where dyspnea occurs. This is also provoked when eating too much oily foods and foods high in sugar. Another factor would be eating too much fast that leaves no room for breathing. Lastly, having food allergies can cause difficulty in breathing. There are cases when allergic reactions are late. One of the symptoms in allergic reaction is difficulty in breathing.
Paroxysmal nocturnal dyspnea happens when the patient is sleeping. Usually at first 2-4 hours of sleeping and has a condition called the left-sided heart failure. This is because of the pulmonary edema. Coughing, wheezing and even sweating are accompanied with this condition.
It is caused by interstitial pulmonary edema and sometimes intraalveolar edema, most commonly as a consequence of left ventricular failure. This condition, usually occurs 2 to 4 hours after sleeping and often accompanied by cough, wheezing, and sweating, may be quite frightening. Paroxysmal nocturnal dyspnea is often ameliorated by the patient’s sitting on the side of the bed or getting out of bed; relief is not instantaneous but usually requires 15 to 30 minutes. Although paroxysmal nocturnal dyspnea secondary to left ventricular failure is usually accompanied by coughing, a careful history often discloses that the dyspnea precedes the cough, not vice versa. Nocturnal dyspnea associated with pulmonary disease is usually relieved after the patient rids himself or herself of secretions rather than specifically by sitting up.
Dyspnea in Dogs
One of the major problems of animals such as dogs is dyspnea. Difficulty breathing among the dogs require immediate attention because it can be life threatening. There are a number of reasons why the dogs are dyspneic. It can be because of a trauma or poison wherein the dog is forcibly hit by a person or against an object or the dog inhaled a poisonous substance. Another factor would be the heat stroke. Yes, dogs are also predisposed to this problem and this requires prompt treatment. It is very important that the dogs are places not directly under the heat of the sun. If the dog owners see that the dogs are having difficulty in breathing in and out, it is best to bring the dog to the veterinarian.
Dyspnea in Pregnancy
During the second and third trimesters, the fetus is growing and so is the abdominal girth. The fundus of the uterus goes up as the week progresses. As this happens, the diaphragm, important muscle for breathing as well as the lungs itself is compressed because of the baby. Thus, difficulty in breathing in pregnancy happens. Another reason is also linked to the hormone progesterone which makes the pregnant woman’s breathing rapid causing dyspnea. These things are temporary since the lungs and diaphragm will be back in its position during the ‘lightening’ period before the delivery.
To treat dyspnea, it is best to know the underlying problem. Medically, medicines are given to treat illnesses such as asthma that can help the patient breathe normally after the attack. Sometimes, when dyspnea is caused by edema in cases of heart failure, diuretics are given. Dyspnea treatment can also be done in non-medical ways such as smoking cessation, exercise as tolerated; elevating the head of bed when lying down or even taking warm bath when secretions are felt in the lungs can take the dyspnea away. If difficulty in breathing still persist, it is best to consult the doctor especially when there are conditions that aggravate the problem.