Inspiratory dyspnea

Periodically recurrent inspiratory dyspnea is a condition that at first a person may not notice, although it often indicates the development of serious diseases. This type of dyspnea is characterized by difficulty in breathing and can be observed in cardiological pathologies, disorders of the diaphragm, pleura, lungs. To clarify the nature of the problem, you should visit a doctor and conduct a comprehensive diagnosis with subsequent therapeutic measures. [1]

Epidemiology

Inspiratory dyspnea is a common reason to contact doctors. This symptom accompanies many diseases, both cardiovascular and respiratory. Difficulty breathing in cardiologic patients usually appears during physical activity (running, fast walking, climbing stairs, muscle exertion). People accustomed to physical exertion may also have breathing problems, but they occur much later, which is explained by the training of the body.

A typical reason for a patient to consult a doctor is the desire to prevent subsequent attacks and exclude the presence of a serious disease. Inspiratory dyspnea can also appear in healthy people with significant physical activity, but it can be classified as pathological manifestations only when the symptom occurs at rest or with habitual exertion. The task of a medical specialist is, first of all, to exclude life-threatening conditions, including bronchial asthma attacks, pulmonary embolism, myocardial infarction and so on.

There are no separate statistics on inspiratory dyspnea. It is known that breathing problems of a permanent nature are present in more than 20% of the world's population. Most often elderly people suffer from such disorders, with men slightly more often than women.

Causes of the inspiratory dyspnea

Dyspnea is roughly divided into these types:

• Cardiac inspiratory dyspnea is due to a deficit in cardiac output.
• Pulmonary inspiratory dyspnea (associated with increased respiratory resistance, decreased surface area for gas exchange and impaired lung elasticity, increased nonvital space, diaphragm paralysis or weakness of respiratory muscles, and chest deformity).
• Extrapulmonary inspiratory dyspnea (caused by pregnancy, obesity, taking certain medications, psycho-emotional shocks, disorders of central regulation, anemia, hypoxia or hypoxemia, metabolic acidosis or febrile states, hyperthyroidism).

In general, inspiratory dyspnea may be due to the following causes:

• angina pectoris, heart failure (accompanied by arrhythmia, swelling of the lower extremities, pain behind the sternum, general weakness);
• Myocardial infarction (combined with chest pain with irradiation to the left arm and back, pallor of the skin, increased sweating);
• pulmonary embolism (occurs suddenly, accompanied by chest pain and coughing, with strengthening on inhalation and turning the body);
• pneumothorax (characterized by accumulation of air or gases in the pleural cavity);
• penetration of a foreign body into the respiratory tract (accompanied by choking, coughing, chest pain);
• diaphragmatic paralysis (can occur with both inspiratory and expiratory dyspnea, as well as headache, blueing of the lips and nasolabial triangle, numbness of the hands);
• intoxication, stress;
• pneumonia, bronchial asthma;
• excessive (extreme) physical activity.

In addition, inspiratory dyspnea is found in laryngotracheitis, craniocerebral trauma, and vascular disease.

Risk factors

Factors that are associated with a high risk of developing inspiratory dyspnea can be roughly divided into two categories:

• that man cannot influence;
• the kind that can be changed.

The first category includes hereditary predisposition and age-related changes, male gender.

The second category includes:

• high cholesterol and triglycerides in the blood;
• high blood pressure;
• smoking, alcohol abuse;
• lack of physical activity, or overexertion;
• overweight;
• diabetes mellitus, bronchial asthma, thyroid disorders;
• stresses.

The main risk factors are those that are directly related to the development of heart failure.

Pathogenesis

The most common immediate underlying cause of dyspnea in patients with respiratory and cardiovascular disorders is pathologically high activity of the respiratory center. This is caused by the influence of the flow of afferent impulsation, which comes from the chemoreceptors of the carotid calf and the ventral part of the medulla oblongata. The process is provoked by changes in the gas composition of blood (hypoxemia, hypercapnia) and pH of arterial blood. The main stimulant of the respiratory center is hypercapnia, causing deepening and increase in respiratory movements and minute ventilation. In severe respiratory insufficiency, the volume of ventilation increases mainly due to increased respiratory movements. The development of metabolic acidosis, in turn, leads to pulmonary hyperventilation, an increase in minute respiratory volume.

Another possible mechanism for the development of inspiratory dyspnea is a decrease in the regulatory function of the respiratory center, which may occur in disorders of cerebral circulation, head injuries, neuroinfectious lesions, intoxication.

The third common mechanism is associated with an increase in the metabolic needs of the body, which is characteristic of anemic conditions, hyperthyroidism.

Symptoms of the inspiratory dyspnea

The common main signs of dyspnea are considered to be:

• rapid breathing;
• blueing of the nasolabial triangle area;
• active participation of accessory muscles in the respiratory act;
• jerking of the head in time with breathing, "groaning" inhalation;
• respiratory pauses.

There are three types of dyspnea: inspiratory dyspnea (problematic inhalation), expiratory dyspnea (problematic exhalation), and mixed dyspnea (difficulty with both inhalation and exhalation). An attack of inspiratory dyspnea develops if the conduction of airflow on inspiration through the upper airways is disturbed. Characteristic signs of an inspiratory attack:

• lengthening, making it difficult to get air into the lungs;
• A heavy, noisy, whistling, groaning breath;
• increasing the depth of breathing movements;
• bradypnea;

Involvement of accessory muscles in the respiratory process, which is associated with reduced air flow into the lungs (intercostal spaces, as well as the jugular, supraclavicular, subclavian fossa and epigastric region are retracted, sometimes - the zone of the garrison sulcus).

Barking cough, hoarseness of voice, and inspiratory dyspnea may be the main signs of stenotic laryngotracheitis - the so-called "false croup", as well as diphtheria (true croup), foreign body in the trachea or gotani, congenital laryngeal or tracheal stenosis, and pharyngeal abscess.

Other possible symptoms include:

• increased chest stiffness (manifestation is characteristic of pleurisy, pneumosclerosis, pulmonary emphysema);
• pain in the chest, behind the sternum, in the heart area, sometimes - when palpating the chest;
• increased vocal tremor (in lung inflammation, atelectasis, pneumosclerosis);
• weakened vocal tremor (with fluid or air accumulation in the pleural cavity).

If there is pulmonary edema, pneumosclerosis or pneumonia, aspiratory dyspnea is accompanied by shortening (dulling) of the percussion sound, which is associated with a decrease in the airiness of the lung. This phenomenon is also characteristic of atelectasis, tumor processes, pleural fluid accumulation.

Inspiratory dyspnea in bronchial asthma or obstructive bronchitis is accompanied by a "boxy" percussion sound, which is associated with a weakening of the elasticity of lung tissue and an increase in its airiness.

A tympanic tone is typical of tuberculous caverns, abscesses, diaphragmatic hernia or pneumocystic masses.

If the patient develops croup, inspiratory dyspnea may be accompanied by a barking cough, hoarseness, inflammation and swelling of the mucous tissues of the larynx. Sometimes there is an increase in body temperature, but not always. The problem usually occurs at night, about the fourth or fifth day of infectious pathology. In most cases, the attack of croup is noted in children under 3 years of age, which is explained by the anatomical features of the respiratory tract.

Inspiratory dyspnea in bronchitis is rare; more often, patients have difficulty exhaling. Other possible symptoms include:

• cough - at first dry, then - productive, moist;
• increase in body temperature to 37-38°C, sometimes - chills, fever;
• signs of intoxication (weakness, loss of appetite, headache, body aches).

In patients with COPD, inspiratory dyspnea is also rare, as chronic pulmonary obstruction is more characterized by expiratory breathing difficulties. The secondary symptoms of COPD are considered to be:

• chronic cough (sometimes with sputum production);
• a feeling of fatigue;
• alternating periods of exacerbation and remission.

Dyspnea of cardiac origin is subjectively manifested by a lack of air, the inability to perform a deep breath, a feeling of compression in the chest, the need to make additional efforts to take a breath.

There is inspiratory dyspnea during physical activity (both heavy and minimal physical activity), or at rest, which is particularly dangerous. Conventionally, difficulty breathing is divided into cardiac, pulmonary and extrapulmonary (caused by other factors). Each of these types of abnormal breathing is accompanied by its own characteristic signs.

Inspiratory dyspnea in children

Inspiratory dyspnea is not only found in the elderly or overweight people. Problems with breathing are often found in children, which is not an independent pathology, but a symptom due to the violation of the work of certain organs.

The main manifestations of inspiratory dyspnea in children:

• Difficulty in breathing regardless of physical activity;
• complaints of shortness of breath;
• convulsive "gulping" of air, severe anxiety;
• a wheezing or wheezing breath;
• Increased respiratory movements (breaths are usually prolonged).

If inspiratory dyspnea in a child occurs after sports training, running or other unusual physical activity, and disappears after 5-10 minutes, there is no cause for concern. However, if the attacks of shortness of breath are prolonged, frequent, if the child is obese or there are other suspicious symptoms, you should definitely consult a pediatrician. Inspiratory dyspnea may indicate the development of such diseases:

• laryngospasm, croup, inflammatory processes of the upper respiratory tract;
• allergic processes;
• pneumonia;
• colds, viral pathologies;
• anemia;
• tumor processes;
• heart defects;
• metabolic disorders, thyroid disease.

In some cases, the appearance of breathing problems is associated with taking certain medications in incorrect dosages.

In children of the first years of life, inspiratory breathing disorder is most often associated with the development of false croup - pathological narrowing of the larynx. As for true croup, this term refers to inflammation of the larynx in diphtheria, when the laryngeal lumen is blocked by dense layers. Due to active vaccination, true croup is extremely rare.

The main cause of common false croup is swelling and narrowing of the respiratory tract due to an active viral infection. In most cases, it is parainfluenza.

Complications and consequences

Regularly occurring inspiratory dyspnea entails a violation of pulmonary gas exchange, which can cause aggravation of the pathological situation and the appearance of the following complications:

• blood pressure fluctuations;
• hypoxemia, increased carbon dioxide in the blood;
• hypoxia, oxygen deficiency in tissues, organs, including the brain;
• attacks of suffocation (especially often - against the background of any, even minimal, physical activity).

Systematic inspiratory dyspnea should not be left unattended, as the symptom is prone to progression. Initially appearing against the background of physical activity, after a while the problem manifests itself at rest, in particular, at night.

The most common consequences of inspiratory dyspnea:

• heart failure;
• respiratory failure;
• pulmonary edema;
• pulmonary emphysema;
• asphyxiation.

Diagnostics of the inspiratory dyspnea

Diagnosis of patients with inspiratory dyspnea is carried out by general practitioners, cardiologists, pulmonologists. Depending on the indications, laboratory and instrumental studies, functional tests are prescribed.

• Determination of external respiratory function - spirometry - is an uncomplicated and informative method that helps to determine the basic indicators of the functionality of the respiratory apparatus. Particularly important indicators are considered vital capacity of the lungs, forced expiratory volume, HR in inspiratory dyspnea. The results obtained allow, in particular, to make a differential diagnosis between bronchial and cardiac pathologies. In addition, a bronchodilatation test may be prescribed.
• X-ray of the chest organs is performed in two projections, which helps to identify changes characteristic of a particular pathology, including emphysema, tumors, diffuse sclerosis. If after radiography doctors still have questions about the disease, additional instrumental diagnostics in the form of computer or magnetic resonance imaging may be prescribed.
• Laryngoscopy - examination with a laryngoscope - is indicated to detect narrowing of the laryngeal lumen, detection of foreign bodies. In addition, tracheobronchoscopy may be used, which allows a more thorough assessment of the bronchial tree and take biomaterial for further cytomorphologic analysis.
• Electrocardiography is necessary to rule out a cardiologic origin of inspiratory dyspnea. If after ECG there are doubts about the diagnosis, additional studies may be prescribed in the form of phonocardiography, echocardiography, cardiac ultrasonography with Doppler ultrasonography. Holter monitoring is indicated in case of recurrent attacks.
• Laboratory tests allow you to assess blood oxygen saturation and carbon dioxide levels, which is necessary to clarify the extent of respiratory disorders. General blood tests are performed to exclude inflammatory processes, anemia. In addition, it is recommended to conduct a biochemical blood test, study of the thyroid gland, blood sugar.

To clarify the causes of inspiratory dyspnea, allergy tests, expanded immunogram are performed. If in the process of radiography suspicious neoplasms are detected, transbronchial lung biopsy may be prescribed.

If cardiovascular causes of inspiratory dyspnea are suspected - in particular, congenital malformations, angina pectoris, myocardial infarction - then consultations with specialized specialists (cardiologist, vascular surgeon, etc.) are carried out.

Differential diagnosis

Often inspiratory dyspnea is provoked by several causes at once, among which the most common is considered to be heart failure. To exclude the cardiac origin of the problem allow such signs:

• absence of cardiac disorders in the anamnesis;
• normal heart size and venous pressure readings;
• normal electrocardiogram and echocardiogram;
• absence of a positive result of stress tests;
• left-sided pleural effusion (in patients with heart failure, the effusion is predominantly right-sided);
• decreased intensity of breath sounds.

The cardiac nature of inspiratory dyspnea is indicated by signs such as:

• heart valve pathology;
• pericardial or myocardial damage;
• other clinical and instrumental manifestations of cardiopathology.

Inspiratory dyspnea in heart disease is associated with swelling of the walls of bronchioles, pulmonary parenchyma, alveoli, or with an imbalance of cardiac output and metabolic needs of the body.

It is important to understand that not all patients with heart failure are accompanied by respiratory impairment. In particular, against the background of taking diuretics, dyspnea can be neutralized, despite the fact that echocardiography demonstrates a decrease in the contractile or diastolic capacity of the myocardium.

Cardiac dyspnea in most cases is inspiratory, weakens in the upright position and at rest, increases in the supine position and during physical activity, accompanied by normal indices of blood gas composition, while pulmonary dyspnea is most often expiratory, accompanied by hypoxemia, hypercapnia and respiratory acidosis.

Cardiac inspiratory dyspnea may result in Cheyne-Stokes respiration, which excludes cerebral disorders and indicates a mismatch between gas tension in the alveoli and central respiratory regulation due to slow blood flow.

Cardiopathology is also manifested by a high and elevated apical push, often down into the VI intercostal space. Exceptions: organ displacement in patients with kyphoscoliosis, keel-shaped or funnel-shaped thorax, high right diaphragmatic dome. Detection of a heartbeat in the lower segment of the sternum, in the IV and V intercostal space on the left indirectly indicates right ventricular enlargement, but also occurs in severe mitral valve insufficiency, which is due to upward and anterior displacement of the heart due to enlargement of the left atrium.

As part of differential diagnosis, pulse is measured symmetrically on the extremities, with assessment of vessel elasticity, frequency and rhythm, filling, shape. Spikes, increased pulsation is characteristic of arterial hypertension, hypermetabolic states, aortic regurgitation, open ductus arteriosus. Two-peak pulse with rapid rise is typical for obstructive-hypertrophic cardiomyopathy.

Inspiratory and expiratory dyspnea

Inspiratory dyspnea is characterized by the appearance of difficulty in taking a breath. The problem most often occurs against the background or after physical exertion - for example, when a person jogged, quickly climbed stairs, carried a heavy load, performed unusual physical effort. This type of shortness of breath is often accompanied by pain in the heart, frequent palpitations, visible pulsation of the neck arteries. With the development of severe cardiologic diseases, inspiratory dyspnea can also appear at rest - for example, when a person sleeps. In most cases, this problem is found in patients over middle age.

Expiratory dyspnea is characterized by the appearance of difficulties with exhalation. The problem is most often caused by respiratory disorders. The attack is usually sudden, without reference to physical exertion. A noisy, prolonged, "whistling" exhalation is noted. The attack may be associated with inhalation of dust, evaporation of paint materials, contact with animals, consumption of certain foods, smoking (including passive).

Treatment of the inspiratory dyspnea

If inspiratory dyspnea occurs suddenly, the person should be calmed down as much as possible, provide a comfortable body position (in which breathing will be as easy as possible: most often it is a semisitting or sitting position, sometimes - a bend with a hand rest). It is advisable to remove outer clothing, undo buttons in the neck and chest area, loosen ties, etc. It is also advisable to open access to fresh air. It is also necessary to open access to fresh air: open a window, doors, or take the patient outside. You can give some sedatives, clean water without gas. If relief does not come, or the condition worsens, it is necessary to urgently consult doctors.

The therapeutic algorithm for inspiratory dyspnea is selected individually, taking into account the cause of this symptom. An important role in the treatment of frequently occurring problems with breathing plays an important role in lifestyle changes and nutritional correction. The patient is recommended:

• to stop smoking altogether;
• minimize alcohol consumption;
• eliminate the use of narcotic drugs;
• Maintain adequate physical activity;
• Minimize the percentage of animal fats in the diet by replacing them with plant-based counterparts;
• see a doctor regularly and have preventive diagnostic tests;
• follow all doctor's orders.

If the diagnosis reveals hypoxemia, the patient is prescribed oxygen therapy. In most cases, etiotropic, symptomatic, pathogenetic therapy is carried out, using the following drugs as indicated:

• bronchodilators, β-adrenomimetics (inhalation), prolonged β2-agonists, methylxanthines;
• expectorants (sometimes in combination with mucolytics);
• antibacterial agents (for acute and chronic inflammatory processes of the respiratory system);
• cardiotonic agents, vasodilators, diuretics (in cardiac disorders);
• Corticosteroids (e.g., for bronchial asthma);
• cytostatic drugs, radiation therapy (for tumor processes).

Drug therapy of heart failure involves the prescription of such drugs:

• diuretics;
• cardiac glycosides;
• nitrates (vasodilators);
• calcium channel blockers;
• β-adrenoblockers.

In particularly complex cases, surgery is indicated (for example, if the disorder is associated with defects in the valve system of the heart).

Diuretics facilitate the work of the heart by activating the excretion of fluid and salt excess in the urine. This reduces the volume of circulating blood, normalizes blood pressure and stabilizes blood circulation.

A special role in the treatment of heart failure is played by the so-called cardiac glycosides - preparations of the foxglove plant. These drugs have a positive effect on the metabolism of myocytes and cardiocytes, increase cardiac contractions, which improves blood supply to internal organs.

In addition, vasodilators (vasodilators) may be used, which affect the condition of peripheral arteries. Thanks to the action of vasodilators, blood flow is facilitated and heart function is improved. Among the most common vasodilators are: nitrates (nitroglycerin), angiotensin-converting enzyme blockers, calcium channel blockers.

Prevention

In order to prevent the occurrence of inspiratory dyspnea, it is important to ensure that these recommendations are followed:

• monitor blood pressure readings;
• Monitor cholesterol and low-density lipoprotein levels in the blood;
• eliminate smoking and the abuse of alcoholic beverages;
• Eat a good and balanced diet, include vegetable food in the diet, exclude fatty meat and animal fats, try to under-salt dishes, avoid the use of convenience foods and fast food;
• Drink enough water daily;
• keep physically active by walking;
• visit the family doctor even in the absence of pathological symptoms, undergo preventive examinations and diagnostics.

People with a tendency to hypertension and cardiovascular pathologies should carefully monitor their condition, take measures to stabilize the heart, regularly visit a cardiologist. Patients suffering from chronic lung diseases and bronchial asthma should carefully take medications prescribed by the attending physician, avoid contact with potential allergens that can provoke an attack of shortness of breath. People who are overweight should increase physical activity, adjust nutrition, thereby normalizing body weight and reducing the load on the cardiovascular apparatus.

Universal preventive methods can be called systematic physical activity, walking, proper nutrition, timely referral to doctors.

Regularly bothersome inspiratory dyspnea always indicates any health problems, so doctors should be consulted in any such cases. Urgent medical attention is required in situations when against the background of breathing difficulties there is pain behind the sternum, fever, severe cough, nausea, vomiting.

Forecast

With timely referral to doctors with the problem of inspiratory dyspnea, with quality diagnosis and competent treatment, the prognosis can be considered favorable. But it is impossible to eliminate the problem without a systemic impact on the initial cause of pathology.

If inspiratory dyspnea is caused by chronic cardiovascular diseases or pathologies of the respiratory apparatus, the patient is necessarily recommended to change lifestyle, adjust diet and physical activity, take supportive medications prescribed by a doctor, if possible to exclude factors that can provoke repeated attacks.

To improve prognosis, it is recommended that:

• systematically perform breathing exercises;
• to control your body weight;
• avoid contact with potential allergens;
• eliminate smoking (both active and passive).

Inspiratory dyspnea can be a dangerous symptom of various serious problems in the body. It is important to find and neutralize the violation in time, so that attacks do not recur in the future.