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Dispnoe
Last reviewed: 17.10.2021
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Many people are familiar with the feeling of lack of air. At such times a person begins to breathe more often and deeper - in order to make up for the lack of oxygen. Similar disturbances of the respiratory process are called dyspnea. This subjective symptom can occur both in acute and chronic forms. Initially, the patient does not even pay attention to this problem, but when she starts to deliver physical discomfort and interferes with ordinary daily activities, there is nothing else than to go to the doctor.
Epidemiology
In general, the prevalence of dyspnea is quite different and depends on age. In the age category of 37-70 years, this indicator is in the range of 6-27%. Children have some pathophysiological features due to their age, so their prevalence of dyspnea rises to 34%. In the first 2 months of life in children, dyspnea is very rare, but in infants older than 2 months this indicator is significantly increased. Often, its appearance is due to the frequent infection of the child with a respiratory syncytial virus. Epidemiological studies have shown that of children who have suffered from shortness of breath in the first 3 years of their life, by the age of 6, it remains at 40%.
Causes of the dyspnoea
Dispnea, or shortness of breath, is one of the most common symptoms of various diseases. It is not only a symptom of chronic lung diseases, it can be associated with a wide range of diseases, such as cancer, heart failure, dementia, as well as neurological disorders such as cerebral aneurysms, amyotrophic lateral sclerosis, AIDS.
Problems with breathing may appear as a result of a variety of reasons. It can be both internal disturbances, and external factors. One of the main external risk factors is poor ecology.
In addition, some diseases, which negatively affect the functioning of the respiratory system, can become the cause. For example, dyspnea can appear during pneumonia, bronchitis, heart disease, laryngitis, heart failure, ARVI, and anemia. The appearance of these diseases disrupts or the very work of the lungs due to arisen edema, or the process of oxygen exchange, as well as blood circulation.
Lack of oxygen may be due to an allergic reaction. The causative factors can be animal hair, various foods, medicines, dust in the home, chemicals, cosmetic products, an insect bite, etc. If such allergic seizures often recur, they can eventually develop into asthma, during which dyspnea is observed often.
Dispnoea also manifests itself in fat people, due to the fact that the cardiovascular system in them is not always capable of providing the necessary amount of oxygen to the tissues. Such people for the appearance of dyspnea is enough even for the most insignificant and not long physical exertion or insignificant excitement.
Pathogenesis
The most convincing theory of the mechanism of appearance and development of dyspnoea is based on how the brain perceives and analyzes the impulses coming to it due to a mismatch between the processes of stretching / straining the respiratory muscles.
In this case, the degree of irritation controlling the tension of the muscles of the nerves, as well as signals transmitted to the brain, differs from the length of the muscles. There is a version that it is because of this discrepancy that it seems to the person that the inspiration he makes is small compared to the tension of the respiratory muscles. The pulses that emanate from the nerve endings into the lungs through the vagus nerve reach the central nervous system and create a conscious or subconscious feeling in the person of breathing problems - dyspnoea.
Thus, it turns out that dyspnea is due to the fact that the brain is excessively activated due to impulses transmitted through the respiratory center located in the medulla oblongata. Shortness of breath will be the harder, the more irritants will appear, as well as disruptions in the work of the respiratory tract.
The arrival of pathological impulses can occur from such departments:
- Nerve centers located in the cerebral cortex;
- Mechano- and baroreceptors in respiratory muscles, as well as other joints and muscle groups;
- Hemoretseptory, which are in the carotid artery (in carotid bodies), the brain, the aorta - they react to a change in the indicator of the concentration of carbon dioxide;
- Receptors that react to changes in the level of acid-base balance in the blood;
- Intramural nerve endings (diaphragmatic as well as vagus nerve).
Symptoms of the dyspnoea
Dispnoea can be defined as "sensation or awareness of discomfort in the process of breathing ... Patients can describe a feeling like shortness of breath, inability to get enough air or choking." It differs from tachypnea (increased respiratory rate) and hypercapnia (increased depth of ventilation).
The presence of symptoms of dyspnea can be said in the case when a person has such signs:
- Pain in the chest, and a feeling of squeezing in it;
- Problems with breathing, arising in humans even at rest;
- The patient can not sleep lying down, he can only fall asleep sitting;
- In the process of breathing, wheezing and wheezing appear;
- Difficulty with swallowing;
- There is a sensation of the presence of a foreign object in the throat;
- For several consecutive days, the temperature rises;
[20]
First signs
The main sign of oxygen shortage is the inhibited communication between the person and the interlocutor - feeling a lack of air, he hardly perceives the questions that are asked of him. Another sign of dyspnoea is the inability of a person to concentrate - the lack of oxygen in the blood has a negative effect on the functioning of the brain.
Dyspnea in the patient is easy to detect - these people are constantly observed such a condition, as if they had just climbed the stairs or fled. Also they are not able to pronounce long phrases and try to breathe deeply, thereby trying to compensate for the lack of air.
Paroxysmal night dyspnea
Paroxysmal night dyspnoea is a sudden onset of shortness of breath in the middle of the night. It looks like this - a sudden awakening due to a severe lack of oxygen. To ease the condition a person has to take a sitting position. In some cases, there is also a whistle in the process of breathing, a cough or a feeling of suffocation. Soon, shortness of breath slows down, after which the person can lie down again and fall asleep. But it also happens that the attack does not decrease, because of which the patient has to sit all night.
Such dyspnea appears due to accumulation in the lung fluid that is observed in chronic heart failure, although it should be noted that such symptoms do not necessarily mean any cardiac pathology of the heart. To ease the condition, the patient has to sleep in the sitting position, since he can not take a horizontal position.
Complications and consequences
The appearance of dyspnea in bronchitis usually indicates that complications of the disease have begun - it has passed into the chronic stage or there were adverse consequences - pleurisy, pneumonia, etc.
Suddenly, severe severe dyspnea may be a symptom of the development of dangerous complications of the bronchopulmonary system. This may also cause pain in the chest. In this case, the patient needs inpatient treatment.
If in the process of obstructive bronchitis attacks dyspnoea are longer and more frequent, you should immediately contact the doctor. The permanent appearance of asthma attacks is dangerous because a person may develop oxygen starvation.
Diagnostics of the dyspnoea
Like pain, shortness of breath is a subjective symptom that depends on many factors, both physiological and psychological. Due to subjectivity, the degree of the patient's dyspnea may not correlate with pulmonary dysfunction, so it is assessed using objective tests such as pulse oximetry, chest X-ray.
In the process of clinical examination of a patient with shortness of breath, the doctor may note the following symptoms: participation in the process of respiration of the auxiliary muscles, the so-called additional signs of chronic oxygen starvation - "drum sticks" and "watch glass", and also the retraction of the supple areas of the sternum during inspiration. In addition, these patients have a rather distinctive appearance - breathing through tightly compressed or folded lips. When diagnosing dyspnea, it is also important to have such manifestations as prolongation of the expiration time, a change in the pattern of functioning of the respiratory muscles, an increase in the index of the respiratory volume, and a decrease in hyperinflation.
[27], [28], [29], [30], [31], [32], [33]
Analyzes
In the process of diagnosing dyspnea, some parameters of gas exchange are evaluated - this is done by pulse oximetry. This is a non-invasive way of assessing how hemoglobin is saturated with oxygen, as well as a laboratory study of the gas composition of the blood (what are the indices of the partial voltage of carbon dioxide and oxygen in the arterial blood).
In addition, an overall blood glucose test is performed in the plasma and electrolytes.
[34], [35], [36], [37], [38], [39], [40], [41], [42], [43]
Instrumental diagnostics
Among the methods of instrumental diagnosis of dyspnea, the following are distinguished: the determination of the ventilation capacity of the lungs, their radiography, and the determination of the parameters of gas exchange.
With the help of radiography, you can diagnose many diseases in which there is shortness of breath - such as pleurisy, pneumonia, benign and malignant lung tumors, tuberculosis, and emphysema of the lungs.
ECG can detect heart rhythm disturbances, overload in its departments, as well as hypoxic changes.
Carrying out procedures for functional diagnostics (such as spirometry, as well as bodipletizmography) makes it possible to determine which disorders are observed in the ventilation of the lungs - obstructive or restrictive, and also to determine the severity of these disorders and whether the reversible bronchial obstruction is possible. In addition, such procedures provide an opportunity to evaluate the effectiveness of the therapy.
Due to the evaluation of the strength of the tension of the respiratory muscles, as well as the neurorespiratory drive, it is possible to detect and control the dynamics of muscle dysfunction, as well as the functioning of the center of respiratory regulation.
In order to assess the gas exchange process, capnometry is carried out (this is how diagnostics of the diffusion capacity of lung functioning is performed).
Differential diagnosis
The first and most important step before the treatment of dyspnea is to conduct an accurate differential diagnosis of this disease. There are several types of dyspnea:
- acute (which lasts for a maximum of 1 hour);
- subacute (which can last up to several days);
- Chronic (which lasts for several years).
Shortness of breath can be a symptom of a variety of diseases, which mainly affect the organs of the cardiovascular system, as well as the respiratory system. Acute dyspnoea can cause diseases such as pneumothorax, myocardial infarction, bronchial asthma, heart rhythm problems, as well as PE and others.
The appearance of subacute dyspnea most often cause pericarditis, pneumonia, metabolic acidosis, pleural effusions, uremia, etc.
Chronic form of the disease can appear as a result of diseases of the heart and blood vessels, bronchial tubes and lungs, and in addition to neurological diseases. Among other reasons: pulmonary ischemia, COPD, cardiomyopathy, pulmonary emphysema, chronic heart failure, anemia and myasthenia gravis, as well as ascites, thyroid diseases, etc.
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Treatment of the dyspnoea
To get rid of dyspnea, you first need to understand why this symptom arose. It should be understood that the lack of timely treatment can lead to complications.
The shortness of breath that arises due to inflammation is treated with antibiotics, which strengthen the immunity of medicines, as well as preparations that help to sputum.
If the patient is diagnosed with heart failure, heart disease or anemia, you should consult a cardiologist who will prescribe treatment to stabilize the condition.
Medications
Disneve is treated with the help of bronchodilating drugs, as well as drugs that reduce the burden on the heart and expectorants:
- beta-adrenomimetics (such as berotek, salbutamol, and also clenbuterol);
- m-holinoblokatory (for example, berodual or atrovent);
- methylxanthines (eg, euphyllin or theophylline) with prolonged action (theopec or theotard);
- inhalation glucocorticoids, used for severe attacks of dyspnea arising from bronchial asthma;
- liquefying and excreting drugs (mucaltin, bromhexine, as well as ambroxol and ATSTS);
- vasodilators with peripheral action (these are calcium antagonists, such as nifedipine, and in addition nitrates such as nitrosorbite, ACE inhibitors that help with symptoms of pulmonary hypertension, such as captopril or enalapril, are also used);
- diuretics that reduce congestion in the lungs (eg, diacarb, furosemide, hypothiazide or veroshpiron);
- antispasmodics (such as a nose-pa or papaverine).
Bromhexine is intended for ingestion in such dosages: children older than 10 years and adults - 1 table. 3-4 rubles / day, children 6-10 years - 1 table. 3 r. / Day, children 2-6 years - 0.5 table. 3 rubles / day. If necessary, the adult dose can be increased to 2 tablets. Four times a day. The drug starts to act 1-2 days after the start of taking the tablets. The treatment course can last at least 4 days and a maximum of 4 weeks.
Among the side effects of the drug - with long reception occasionally there may be digestive disorders, vomiting and nausea, as well as peptic ulcer exacerbations. Among the relative contraindications to admission - peptic gastric ulcer, hypersensitivity to the drug, the first trimester of pregnancy and recent bleeding in the stomach.
Captopril is taken only in individual mode. The daily dose varies within the limits of 25-150 mg (to use it is necessary in 3 receptions). If a patient has heart failure in a chronic form, 12.5-25 mg of medication should be taken three times a day. A day is allowed to take no more than 150 mg. To children the dosage is appointed, proceeding from parameters of body weight - on 1 kg of weight on 1-2 mg. Take the medicine you need on an empty stomach.
Side effects of the drug - a rash on the skin, increasing the level of urine output, leukopenia, an increase in creatinine in the plasma, as well as a sharp drop in the amount of granulocytes in the blood.
Among the contraindications to admission:
- Hypersensitivity.
- Stenosis of the renal arteries;
- Stenosis of the mitral valve or aorta.
- Heart diseases of unknown etiology, myocarditis of different etiology.
- Primary hyperaldosteronism (the so-called increased production of aldosterone, which arises from a tumor in the adrenal cortex, which also shows swelling, increased blood pressure, ascites, or because of hyperplasia).
- Pregnancy, as well as the period of lactation.
- The age is under 14 years.
Caution should be used to appoint Captopril to patients who are engaged in activities that require them to react quickly, as well as full concentration. Also, during the treatment with Captopril, you should not drink alcoholic beverages.
Berodual is prescribed for children from 3 years and adults in a dosage of 1-2 sprays three times a day. If respiratory failure is present, two sprays can be made, and then, if necessary, two more sprays after 5 minutes. After that, the next inhalation can be done at least 2 hours later. Inhalation solution is taken in a dosage of 2-8 drops of 3-6 r. / Day. The intervals between receptions should be at least 2 hours. If you use an electrosprayer, you need 4 drops. Drug with the addition of 3 ml of sodium chloride (isotonic solution). The solution is inhaled for 5-7 minutes, until all the liquid is complete. If a manual nebulizer is used, you should inhale the undiluted solution (20-30 breaths).
Side effects: problems with visual perception, dryness in the oral cavity, tremor in the fingers, glaucoma, increased heart rate, tachyarrhythmia.
The drug should not be taken on the 1st trimester of pregnancy. Also, it is not recommended to use it shortly before birth, since fenoterol depresses the generic function. Do not use in combination with noncardioselective beta-blockers and xanthine derivatives.
Vitamins
When dyspnea appears in the absence of any heart disease or excess weight, it is necessary to determine the level of hemoglobin - in this case, the cause of its appearance may be iron deficiency anemia. In such situations, treatment is carried out with the help of iron-containing drugs. And that the body better absorbed the iron contained in these preparations, doctors prescribe vitamin C.
Alternative treatment
To eliminate shortness of breath, alternative methods of treatment can be used. There are several recipes that help with this pathological symptom.
We make from a dozen squeezed lemons (use their juice) and a dozen garlic heads gruel, after which we fill this mixture in a jar with honey (1 liter), close and leave to insist for a week. The drug is taken in a dosage of 4 tsp. Daily. The treatment course should last approximately 2 months.
Another good way is to use lemon juice (take 24 lemon) with garlic paste (350 gr.). We insist this mixture for 1 day, after which we drink 1 tsp daily, dissolving it first in 0.5 stack. Water.
Herbal Treatment
To treat dyspnea, medicinal herbs are also often used.
Against dyspnea and cough, a drink made of aloe leaves is very effective, which was infused for 10 days in vodka. To take it is necessary for 1 tsp, after which 1 st.lozh. Honey. After 10 minutes you need to drink 1 cup. Hot tea.
Stabilization of the respiratory process contributes tincture of astragalus grass. It is necessary to take 1 item. Of the sliced ingredient, pour it 1 stack. Boiling water, then insist for 1.5 hours and then strain. The medication is administered four times a day before meals, 50 ml each. If desired, sugar can be added to the tincture or honey for taste.
The respiratory rhythm stabilizes the infusion of sunflower flowers. Take 100 g of dry ingredient and pour 400 ml of vodka. The resulting mixture should be infused for 2 weeks. The drug should be taken before meals 3 r. / Day. 35 drops each.
Homeopathy
In the treatment of dyspnea, homeopathic remedies are also used.
Apis-Gomakord is administered intramuscularly, subcutaneously or intravenously. It is necessary to use 1 ampoule 2-3 r. / Week. If the dyspnea is acute, 1 ampoule should be administered daily. In the drops it is used for 10 drops. 2-4 rubles / day. Children can not take this medicine. Sometimes, as a result of taking the drug, a temporary aggravation of the symptoms of the disease occurs - in such a situation it is necessary to interrupt the reception for a while and consult the doctor.
Sambucus Plus should be taken sublingually (until fully absorbed), half an hour before meals or 1 hour after eating. Take it also in the intervals between meals - 8 granules 5 r. / Day. The drug is contraindicated for high sensitivity. Among the side effects is an allergy to the drug.
Ipecacuan is usually prescribed as one of the components of the combined treatment, although in itself this drug is quite effective. The dosage of the drug and the duration of therapy are prescribed individually - this can only be done by a doctor. The way of use also depends on what kind of dosage form the patient will take. Among the contraindications - Ipecacuanu can not be taken by those who have high sensitivity to any components of the drug, as well as during lactation and pregnancy. In general, the drug is safe, since it is of vegetable origin. Among the adverse reactions are some allergic reactions, nausea. But if you follow the doctor's instructions in everything, such effects are unlikely.
Operative treatment
Sometimes, when shortness of breath, surgical treatment is called surgical reduction of the lungs. Indications for a similar procedure that reduces the severity of dyspnea are diseases such as emphysema.
To reduce dyspnea in patients who have massive bulbs in their lungs (more than one-third the size of hemithorax), doctors perform a procedure for unilateral Bullectomy.
When emphysema, patients suffering from severe hyperinflation carry out bilateral reductions. This procedure reduces the rate of dynamic hyperinflation, and also contributes to the improvement of pulmonary ventilation. Among alternative methods of operative treatment of emphysema is the introduction into the lung of an umbellar valve through bronchoscopy.