Symptoms of dyspnoea

In typical cases, patients characterize shortness of breath as:

• difficulty breathing;
• a feeling of tightness in the chest and lack of air during inspiration;
• impossibility of deep inspiration and / or complete exhalation.

[1]

Inspiratory dyspnea

It is especial accompanied by inclusion in the act of respiration of auxiliary respiratory muscles that is shown also in the form of an entrainment of subclavian pits, epigastric region, intercostal spaces, tension of the sternocleidomastoid muscle.

The most common type of dyspnoea is a mixed type, in which one can see a chest swelling and an entrainment of the above areas.

Dyspnea with heart disease - inspiratory. It manifests inadequate (not corresponding to the condition and conditions in which the patient is) faster and more breathing: first with little physical exertion, sharply increasing with considerable physical effort, and then at rest, it can increase after eating, especially in horizontal position, forcing of patients to sit (orthopnea). Such attacks are sometimes called "cardiac asthma," and dyspnea becomes mixed. Typically, the patient wakes up with a feeling of lack of air, sits in bed or goes to the window to get some fresh air. After half an hour the patient becomes lighter, he goes to bed and can sleep through the morning or 2-3 hours again to wake up from a repeated attack. At its extreme, dyspnea becomes choking.

Expiratory breathlessness

With expiratory dyspnoea, exhalation is slow, sometimes with a whistle; the thorax almost does not take part in the act of breathing, as if being in a position of constant inspiration.

With bronchial obstruction or loss of elasticity of the lung tissue (for example, with chronic emphysema of the lungs), expiratory dyspnea occurs. A significant decrease in the respiratory surface of the lungs is manifested by mixed dyspnoea, which may be temporary or permanent. It is observed in pneumonia, pleurisy, severe emphysema, fibrosing alveolitis (initially inspiratory) and other pathological conditions of the lungs. When 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 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 (it is difficult not only to inhale, but also to exhale), breathing becomes noisy, audible at a distance (stridorous breathing).

In diseases of the respiratory system, shortness of breath is usually subjective, and objective at the same time. With emphysema, dyspnea is sometimes only objective; it is the same for obliteration of the pleura. With hysteria, thoracic radiculitis, it is only subjective.

Dyspnoea in the form of tachypnea is observed with inflammation of the lungs, bronchogenic cancer, tuberculosis. With pleurisy, breathing becomes superficial and painful; with embolism or thrombosis of the pulmonary artery suddenly comes a sharp, often painful shortness of breath with a deep breath and exhalation, sometimes in a lying position.

And pediatric practice as a clinically important criterion is the constant nature of dyspnea. In this case, it is possible to suspect cystofibrosis, congenital anomalies of the respiratory tract or heart, aspiration of the foreign body.

Characterized by a feeling of general discomfort due to insufficient oxygenation of blood and tissues. Patients describe their feelings associated with shortness of breath, in different ways - "there is not enough air", "the feeling is squeezed in the chest, behind the sternum, in the throat", "fatigue in the chest," "I can not breathe in full," "I snap the air open my mouth , "I breathe like a fish", etc.

A very important clinical characteristic of dyspnoea is its connection with exercise. If in the initial stages of the disease shortness of breath occurs only with a significant physical effort (for example, a rapid ascent of the stairs to several floors), then in expanded stages it appears already with everyday simple actions (for example, tying up laces) and even at rest.

Dyspnoea may occur in chronic respiratory system diseases accompanied by sputum separation - in this case, dyspnea is associated with the accumulation of sputum in the airways and after transition to a vertical position (postural drainage effect) and coughing decreases.

Questions to ask a patient with shortness of breath:

• How long has shortness of breath?
• Is dyspnea constant or does it occur from time to time?
• What causes or enhances dyspnea?
• What is the manifestation of dyspnea?
• How much does it limit physical activity?
• What makes dyspnea easier?

[2], [3], [4], [5], [6], [7], [8], [9], [10]