Shortness of breath – what are its causes?
- 04 December 2020 09:32:13
- Views: 689
Shortness
of breath, also known as dyspnea, is an unpleasant, subjective feeling of not
being able to breathe well enough and not getting enough air. In healthy
persons, it usually occurs after intense physical activity. When it is a
symptom of a disease, it may take the form of effort dyspnea (occurring during
activities of varying intensity) or dyspnea at rest (occurring while being
idle).
What is shortness of breath?
Dyspnea is
defined as a feeling of being short of breath and having difficulty breathing.
It can be a physiological symptom, that is, it can occur in healthy people
during significant physical exertion and disappears after rest. If, on the
other hand, shortness of breath is caused by negligible physical effort, daily
activity, or even it occurs when a person is at rest - it can be a pathological
symptom.
Based on
its duration, shortness of breath is divided into two categories:
Acute
dyspnea - it develops relatively quickly, although depending on its cause,
"quickly" can mean anywhere from a few seconds to several days. It
lasts until its causes are eliminated or effective treatment is applied.
Chronic dyspnea - lasts for an extended period of time,
increases gradually, initially being a symptom of hard effort, and over time
becoming also a resting symptom.
Based on
the circumstances of occurrence, dyspnea is divided into:
effort
dyspnea - occurs during intense physical activity,
dyspnea at
rest - occurs even when the patient is lying idly in bed, without any physical
activity.
In
addition, there are specific types of dyspnea that appear or worsen depending
on the patient's body position. These include:
orthopnoë –
occurs when lying down and subsides when the patient sits or stands up,
platypnoë – occurs
when standing or sitting and is relieved after lying down.
How dyspnea develops
The
mechanisms of dyspnea’s development are very complex and not fully understood. Dyspnea
is triggered based on interactions between neurological centers located in the
cerebral cortex and the medulla, as well as signals received and transmitted by
receptors located in the lungs, chest, and chemoreceptors responding to blood
gas concentration.
There are two
basic mechanisms of dyspnea’s formation:
The first
of those is tissue hypoxia happening as a result of:
respiratory
insufficiency - a disturbance of proper gas exchange in the lungs, leading to a
decrease in the concentration of oxygen in the arterial blood and an increase
in the concentration of carbon dioxide contained in it, which causes a
reduction in the amount of oxygen supplied to the tissues,
a decrease
in cardiac output – a reduction in the volume of blood supplied by the
heart, resulting in a lowered blood supply and thus inadequate tissue
oxygenation,
anemia - a
decrease in the concentration of hemoglobin, which is used to transport oxygen
in the blood.,
poisoning with
substances that reduce the body’s ability to bind hemoglobin with oxygen, e.g.
carbon monoxide,
The second
factor causing dyspnea is hyperventilation, caused by excessive stimulation of
the respiratory center resulting from:
the reduced
diameter of the airways caused by obstructive diseases such as asthma or COPD,
the reduction
in the lungs’ functional surface, where gas exchange takes place, as a result
of heart disease with pulmonary congestion, interstitial lung diseases, chest
deformities, or pleural diseases,
weakened respiratory
muscles in muscle and neuromuscular diseases,
the reduction
of blood supply to the lungs in pulmonary embolism,
disturbances
in the acid-base balance, particularly in metabolic acidosis,
the functioning
of intrinsic (e.g. uremic toxins in renal failure) and extrinsic toxicants (e.g.
salicylates),
the body’s reaction
to strong emotional or physical stimuli,
intense
exercise.
Shortness of breath – causes
The most
important pathological causes of dyspnea include:
chronic
obstructive pulmonary diseases,
bronchial
asthma,
interstitial
lung diseases,
bronchiectasis,
primary and
metastatic lung cancer,
chronic and
acute heart failure,
myocardial
infarction,
infectious
diseases of the respiratory system - pneumonia, bronchitis, tuberculosis,
pneumothorax,
anemia,
pulmonary
embolism,
foreign
body in the airways,
muscle and
neuromuscular diseases,
metabolic
acidosis,
poisoning.
Shortness of breath - diagnosis and treatment
Numerous laboratory, imaging, and functional tests can be
used when diagnosing dyspnea, and which of those are necessary is decided based
on the symptom's suspected cause. And so, in the diagnosis of obstructive pulmonary disease, spirometry
will be necessary, when suspecting a neoplastic disease, computed tomography is
used, and in heart failure - echocardiography. Laboratory tests can reveal
acid-base disorders, possible increases in inflammatory parameters, or an
increase in BNP indicating worsening of heart failure.
Treatment
is also usually tailored to the dyspnea's cause. In obstructive diseases, it is
aimed at bronchodilation, in heart failure - diuretic treatment, and in
infectious diseases - antimicrobial treatment.
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