Symptoms of shortness of breath

In typical cases, patients describe 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 exhale completely.

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Inspiratory dyspnea

Usually accompanied by the inclusion of auxiliary respiratory muscles in the act of breathing, which manifests itself in the form of retraction of the subclavian fossae, epigastric region, intercostal spaces, and tension of the sternocleidomastoid muscle.

The most common type of dyspnea is mixed, in which one can see swelling of the chest and retraction of the above-mentioned areas.

Dyspnea in heart diseases is inspiratory. It manifests itself as inadequate (not corresponding to the condition and conditions in which the patient is) increased frequency and intensity of breathing: initially with minor physical exertion, increasing sharply with significant physical effort, and then at rest, it can increase after eating, especially in a horizontal position, forcing patients to sit (orthopnea). Such attacks are sometimes called "cardiac asthma", and dyspnea acquires a mixed character. 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 breathe fresh air. After half an hour, the patient feels better, he goes to bed and can sleep until the morning or wake up again in 2-3 hours from a repeated attack. In its extreme degree, dyspnea turns into suffocation.

Expiratory dyspnea

With expiratory dyspnea, exhalation is slow, sometimes with a whistle; the chest takes almost no part in the act of breathing, as if it were in a position of constant inhalation.

Expiratory dyspnea occurs with bronchial obstruction or loss of elasticity of the lung tissue (for example, with chronic pulmonary emphysema). A significant reduction in the respiratory surface of the lungs is manifested by mixed dyspnea, which can be temporary or permanent. It is observed in pneumonia, pleurisy, severe emphysema, fibrosing alveolitis (initially inspiratory) and other pathological conditions of the lungs. With emphysema, some patients exhale with closed lips (puff).

The appearance of a mechanical obstruction in the upper respiratory tract (in the 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, dyspnea becomes mixed (not only inhalation but also exhalation is difficult), breathing becomes noisy, audible at a distance (stridor breathing).

In diseases of the respiratory organs, dyspnea is usually both subjective and objective at the same time. In emphysema, dyspnea is sometimes only objective; it is the same with pleural obliteration. In hysteria, thoracic radiculitis, it is only subjective.

Dyspnea in the form of tachypnea is observed in pneumonia, bronchogenic cancer, tuberculosis. In pleurisy, breathing becomes shallow and painful; in embolism or thrombosis of the pulmonary artery, sudden, often painful dyspnea with deep inhalation and exhalation occurs, sometimes in a lying position.

In pediatric practice, a clinically important criterion is the constant nature of dyspnea. In this case, one can suspect cystic fibrosis, congenital anomalies of the respiratory tract or heart, aspiration of a foreign body.

A feeling of general discomfort due to insufficient oxygen saturation of blood and tissues is typical. 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", "tiredness in the chest", "cannot fully inhale", "I gasp for air with an open mouth, "breathe like a fish", etc.

A very important clinical characteristic of dyspnea is its connection with physical exertion. If at the initial stages of the disease dyspnea occurs only with significant physical effort (for example, quickly climbing several floors of stairs), then in the advanced stages it appears already with simple everyday actions (for example, tying shoelaces) and even at rest.

Shortness of breath may occur in chronic respiratory diseases accompanied by the separation of sputum - 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 the cough decreases.

Questions to ask a patient with shortness of breath:

• How long have you been experiencing shortness of breath?
• Is shortness of breath constant or does it occur from time to time?
• What causes or worsens shortness of breath?
• How severe is the shortness of breath?
• How much does it limit physical activity?
• What relieves shortness of breath?

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