Dyspnea

Many people are familiar with the feeling of lack of air. At such moments, a person begins to breathe more often and deeply - in order to compensate for the lack of oxygen. Such respiratory disorders are called dyspnea. This is a subjective symptom, can occur in both acute and chronic forms. At first, the patient does not even pay attention to this problem, but when it begins to cause physical discomfort and interfere with the performance of ordinary daily activities, there is nothing left to do but consult a doctor.

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Epidemiology

In general, the prevalence of dyspnea varies greatly and depends on age. In the age category of 37-70 years, this figure is within 6-27%. Children have some pathophysiological features due to their age, so the prevalence of dyspnea increases to 34%. In the first 2 months of life, dyspnea is very rare in children, but in infants over 2 months, this figure increases significantly. Often, its appearance is associated with frequent infection of the child with the respiratory syncytial virus. Epidemiological studies have shown that of children who suffered from dyspnea in the first 3 years of their life, by the age of 6 it persists in 40%.

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Causes dyspnea

Dyspnea, or shortness of breath, is one of the most common symptoms of various diseases. It is not only a symptom of chronic lung diseases, but can be associated with a wide range of diseases such as cancer, heart failure, dementia, and neurological disorders such as cerebral aneurysm, amyotrophic lateral sclerosis, and AIDS.

Breathing problems can occur due to a variety of reasons. These can be both internal disorders and external factors. One of the main external risk factors is poor ecology.

In addition, the cause may be some diseases that negatively affect the functioning of the respiratory system. For example, dyspnea may appear during pneumonia, bronchitis, heart defects, laryngitis, heart failure, acute respiratory viral infections, and anemia. The appearance of these diseases disrupts either the functioning of the lungs themselves due to the resulting edema, or the process of oxygen exchange, as well as blood circulation.

Lack of oxygen may occur due to an allergic reaction. The causative factors may be animal hair, various foods, medications, dust in the house, chemicals, cosmetics, insect bites, etc. If such allergic attacks are repeated frequently, over time they can develop into asthma, during which dyspnea is observed quite often.

Dyspnea also occurs in overweight people, due to the fact that their cardiovascular system is not always able to provide the necessary amount of oxygen to the tissues. For such people, even the most insignificant and short-term physical activity or minor anxiety is enough to cause shortness of breath.

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Pathogenesis

The most convincing theory of the mechanism of the onset and development of dyspnea is based on how the brain perceives and analyzes impulses coming to it due to the discrepancy between the processes of stretching/tensioning the respiratory muscles.

In this case, the degree of irritation of the nerves that control muscle tension, 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 a person that the breath he takes is too small compared to the tension of the respiratory muscles. Impulses emanating from the nerve endings to the lungs through the vagus nerve reach the central nervous system and create a conscious or subconscious feeling of breathing problems in a person - dyspnea.

Thus, it turns out that shortness of breath occurs because the brain is over-activated by impulses transmitted through the respiratory center located in the medulla oblongata. The more severe the irritants and the disturbances in the functioning of the respiratory tract, the more severe the shortness of breath.

Pathological impulses can come from the following areas:

• Nerve centers located in the cerebral cortex;
• Mechano- and baroreceptors in the respiratory muscles, as well as other joints and muscle groups;
• Chemoreceptors, which are located in the carotid artery (in the carotid bodies), brain, aorta - they react to changes in the concentration of carbon dioxide;
• Receptors that respond to changes in the acid-base balance in the blood;
• Intrathoracic nerve endings (phrenic and vagus nerve).

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Symptoms dyspnea

Dyspnea can be defined as "a sensation or awareness of discomfort during breathing...patients may describe the feeling as shortness of breath, inability to get enough air, or suffocation." It is distinct from tachypnea (increased respiratory rate) and hypercapnia (increased depth of ventilation).

The presence of symptoms of dyspnea can be said to occur when a person exhibits the following signs:

• Pain in the chest, as well as a feeling of pressure in it;
• Breathing problems that occur in a person even when at rest;
• The patient cannot sleep lying down; he can only fall asleep sitting up;
• Wheezing and whistling sounds appear during breathing;
• Difficulty swallowing;
• There is a feeling of a foreign object in the throat;
• The temperature rises for several days in a row;

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First signs

The main sign of lack of oxygen is a person's inhibited communication with the interlocutor - feeling a lack of air, he has difficulty perceiving the questions that are asked of him. Another sign of dyspnea is a person's inability to concentrate - a lack of oxygen in the blood negatively affects the functioning of the brain.

Shortness of breath in a patient is quite easy to detect - such people constantly have a condition as if they have just climbed a long flight of stairs or run. They are also unable to pronounce long phrases and try to breathe deeply, thereby trying to compensate for the lack of air.

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Paroxysmal nocturnal dyspnea

Paroxysmal nocturnal dyspnea is an attack of shortness of breath that suddenly occurs in the middle of the night. It looks like this: a sudden awakening due to a severe lack of oxygen. To relieve the condition, a person has to sit up. In some cases, wheezing, coughing, or a feeling of suffocation also occurs. Soon, the shortness of breath gradually subsides, after which the person is able to lie down again and fall asleep. But it also happens that the attack does not subside, which is why the patient has to sit up all night.

Such shortness of breath appears due to accumulation of fluid in the lungs, which is observed in chronic heart failure, although it should be noted that such symptoms do not necessarily mean any cardiac pathology. To alleviate the condition, the patient has to sleep in a sitting position, since he cannot take a horizontal position.

Complications and consequences

The occurrence of dyspnea in bronchitis usually indicates that complications of the disease have begun - it has become chronic or unfavorable consequences have appeared - pleurisy, pneumonia, etc.

Sudden severe shortness of breath may be a symptom of the development of dangerous complications of diseases of the bronchopulmonary system. In this case, chest pain may also occur. In such a case, the patient requires inpatient treatment.

If during obstructive bronchitis attacks of dyspnea become longer and more frequent, you should immediately contact a doctor. The permanent appearance of attacks of suffocation is dangerous because a person may develop oxygen starvation.

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Diagnostics dyspnea

Like pain, dyspnea is a subjective symptom that depends on many factors, both physiological and psychological. Due to subjectivity, the degree of dyspnea in a patient may not correlate with pulmonary dysfunction, so it is assessed using objective tests such as pulse oximetry, chest X-ray.

During a clinical examination of a patient with dyspnea, the doctor may note the following symptoms: the involvement of accessory muscles in the breathing process, the so-called additional signs of chronic oxygen starvation - "drumsticks" and "watch glasses", as well as retraction of the pliable areas of the sternum when inhaling. In addition, such patients have a fairly characteristic appearance - breathing through loosely compressed or pursed lips. When diagnosing dyspnea, it is also important to have such manifestations as an increase in the time of exhalation, a change in the pattern of functioning of the respiratory muscles, an increase in the respiratory volume indicator and a decrease in hyperinflation.

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Tests

In the process of diagnosing dyspnea, an assessment of some parameters of gas exchange is carried out - this is done using pulse oximetry. This is a non-invasive method of assessing how hemoglobin is saturated with oxygen, as well as a laboratory study of the gas composition of the blood (what are the indicators of partial pressure of carbon dioxide, as well as oxygen in arterial blood).

In addition, a general blood test is performed for plasma glucose and electrolytes.

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Instrumental diagnostics

Among the methods of instrumental diagnostics of dyspnea, the following stand out: determination of the ventilation capacity of the lungs, their radiography, and determination of gas exchange parameters.

X-rays can be used to diagnose many diseases that cause shortness of breath, such as pleurisy, pneumonia, benign and malignant lung tumors, tuberculosis, and pulmonary emphysema.

ECG allows us to identify disturbances in heart rhythm, overload in its sections, as well as hypoxic changes.

Conducting functional diagnostic procedures (such as spirometry and body plethysmography) makes it possible to determine what disorders are observed in lung ventilation - obstructive or restrictive, as well as to find out the severity of these disorders and whether the resulting bronchial obstruction can be reversible. In addition, such procedures make it possible to evaluate the effectiveness of the therapy.

By assessing the strength of tension in the respiratory muscles, as well as the neurorespiratory drive, it is possible to identify and control the dynamics of muscle dysfunction, as well as the functioning of the respiratory regulation center.

In order to assess the gas exchange process, capnometry is performed (this is the name given to the diagnostics of the diffusion capacity of the lungs).

Differential diagnosis

The first and most important step before starting treatment for dyspnea is to conduct an accurate differential diagnosis of this disease. There are several types of dyspnea:

• acute (lasting 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 cardiovascular system, as well as the respiratory system. Acute dyspnea can be caused by diseases such as pneumothorax, myocardial infarction, bronchial asthma, heart rhythm problems, as well as pulmonary embolism, etc.

The appearance of subacute dyspnea is most often caused by pericarditis, pneumonia, metabolic acidosis, pleural effusions, uremia, etc.

The chronic form of the disease may appear as a result of diseases of the heart and blood vessels, bronchi and lungs, and in addition to this, neurological diseases. Among other causes: pulmonary ischemia, COPD, cardiomyopathy, pulmonary emphysema, chronic heart failure, anemia and myasthenia, as well as ascites, thyroid disease, etc.

Treatment dyspnea

To get rid of dyspnea, you must first understand why this symptom arose. It should be understood that the lack of timely treatment can lead to the development of complications.

Shortness of breath caused by inflammation is treated with antibiotics, immune-boosting medications, and drugs that promote expectoration.

If the patient is diagnosed with heart failure, heart disease or anemia, a cardiologist should be consulted, who will prescribe treatment to stabilize the condition.

Medicines

Dyspnea is treated with bronchodilators, as well as drugs that reduce the load on the heart and expectorants:

• beta-adrenergic agonists (such as berotek, salbutamol, and clenbuterol);
• m-anticholinergics (for example, Berodual or Atrovent);
• methylxanthines (eg, aminophylline or theophylline) with prolonged action (teopec or theotard);
• inhaled glucocorticoids used for severe attacks of shortness of breath that occur in bronchial asthma;
• drugs that thin and remove phlegm (mucaltin, bromhexine, as well as ambroxol and ACC);
• vasodilators with peripheral action (these are calcium antagonists such as nifedipine, as well as nitrates such as nitrosorbitol; ACE inhibitors are also used to help with the symptoms of pulmonary hypertension - drugs such as captopril or enalapril);
• diuretics that reduce congestion in the lungs (for example, diacarb, furosemide, hypothiazide or veroshpiron);
• antispasmodics (such as no-shpa or papaverine).

Bromhexine is intended for oral administration in the following dosages: children over 10 years of age and adults - 1 tablet 3-4 times a day, children 6-10 years of age - 1 tablet 3 times a day, children 2-6 years of age - 0.5 tablet 3 times a day. If necessary, the dose for adults can be increased to 2 tablets four times a day. The drug begins to act 1-2 days after the start of taking the tablets. The treatment course can last a minimum of 4 days and a maximum of 4 weeks.

Side effects of the drug include occasional digestive disorders, vomiting and nausea, and exacerbations of gastric ulcers when taken for a long time. Relative contraindications include peptic ulcers, hypersensitivity to the drug, first trimester of pregnancy and recent bleeding in the stomach.

Captopril is taken only on an individual basis. The daily dose varies between 25-150 mg (to be taken in 3 doses). If the patient has chronic heart failure, 12.5-25 mg of the drug should be taken three times a day. No more than 150 mg is allowed per day. For children, the dosage is prescribed based on body weight - 1-2 mg per 1 kg of weight. The drug should be taken on an empty stomach.

Side effects of the drug include skin rash, increased levels of protein excreted in the urine, leukopenia, increased plasma creatinine levels, and a sharp drop in the number of granulocytes in the blood.

Contraindications to taking it include:

• Hypersensitivity.
• Renal artery stenosis;
• Mitral valve or aortic stenosis.
• Heart diseases of unknown etiology, myocarditis of various etiologies.
• Primary hyperaldosteronism (this is the name given to increased production of aldosterone, which occurs due to a tumor in the adrenal cortex, which also causes swelling, increased blood pressure, ascites, or due to hyperplasia).
• Pregnancy and lactation period.
• Age under 14 years.

Captopril should be prescribed with caution to patients who are engaged in activities that require them to react quickly and have full concentration. Also, during treatment with Captopril, alcoholic beverages should not be consumed.

Berodual is prescribed to children aged 3 years and over and adults in a dosage of 1-2 sprays three times a day. If there is respiratory failure, 2 sprays can be made, and then, if necessary, 2 more sprays after 5 minutes. After that, the next inhalation can be done at least 2 hours later. The inhalation solution is taken in a dosage of 2-8 drops 3-6 times a day. The intervals between doses should be at least 2 hours. If an electric nebulizer is used, 4 drops of the drug are needed with the addition of 3 ml of sodium chloride (isotonic solution). The solution is inhaled for 5-7 minutes until all the liquid is gone. If a hand nebulizer is used, the undiluted solution must be inhaled (20-30 breaths).

Side effects: problems with visual perception, dry mouth, tremors in the fingers, glaucoma, increased heart rate, tachyarrhythmia.

The drug should not be taken in the first trimester of pregnancy. It is also not recommended to use it shortly before delivery, since fenoterol inhibits labor function. It should not be used in combination with non-cardioselective beta-blockers and xanthine derivatives.

Vitamins

When dyspnea occurs in the absence of any heart disease or excess weight, the hemoglobin level should be determined - in this case, the cause of its appearance may be iron deficiency anemia. In such situations, treatment is carried out with iron-containing drugs. And in order for the body to better absorb the iron contained in these drugs, doctors prescribe vitamin C.

Folk remedies

To eliminate shortness of breath, you can use folk remedies. There are several recipes that help with this pathological symptom.

We make a gruel from ten squeezed lemons (their juice is used) and ten heads of garlic, then pour this mixture into a jar with honey (1 l), close and leave to infuse for a week. The medicine is taken in a dosage of 4 teaspoons daily. The treatment course should last about 2 months.

Another good way is to use lemon juice (take 24 lemons) with the addition of garlic gruel (350 g). Infuse this mixture for 1 day, then drink 1 teaspoon daily, dissolving it in 0.5 cups of water beforehand.

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Herbal treatment

Medicinal herbs are also often used to treat dyspnea.

A drink made from aloe leaves steeped in vodka for 10 days is very effective against shortness of breath and cough. Take 1 teaspoon, followed by 1 tablespoon of honey. After 10 minutes, drink 1 cup of hot tea.

A tincture of astragalus herb helps stabilize the respiratory process. Take 1 tbsp. of the chopped ingredient, pour 1 cup of boiling water over it, then leave it for 1.5 hours and then strain. The medicine is taken four times a day before meals, 50 ml. If desired, you can add sugar or honey to the tincture for taste.

The respiratory rhythm is stabilized by an infusion of sunflower flowers. Take 100 g of the 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 times a day, 35 drops at a time.

Homeopathy

Homeopathic medicines are also used in the treatment of shortness of breath.

Apis-Gommakord is administered intramuscularly, subcutaneously or intravenously. It is necessary to use 1 ampoule 2-3 times a week. If dyspnea is acute, 1 ampoule should be administered daily. In drops, it is used 10 drops 2-4 times a day. Children should not take this medicine. Sometimes, as a result of taking the drug, a temporary exacerbation of the symptoms of the disease occurs - in such a situation, you need to stop taking it for a while and consult a doctor.

Sambucus Plus should be taken sublingually (until completely dissolved), half an hour before meals or 1 hour after meals. It is also taken between meals - 8 granules 5 times a day. The drug is contraindicated in case of high sensitivity. Side effects include allergy to the drug.

Ipecac is usually prescribed as one of the components of combination therapy, although this medicine is quite effective on its own. The dosage of the drug and the duration of therapy are prescribed individually - this can only be done by a doctor. The method of use also depends on what dosage form the patient will take. Among the contraindications - Ipecac cannot be taken by those who have a 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 plant origin. Side effects include some allergic reactions, nausea. But if you follow the doctor's instructions in everything, such effects are unlikely.

Surgical treatment

Sometimes, shortness of breath is treated surgically, which is called surgical lung reduction. Indications for such a procedure, which reduces the severity of dyspnea, are diseases such as emphysema.

To reduce shortness of breath in patients who have massive bullae in the lungs (larger than 1/3 of the hemithorax), doctors perform a unilateral bullectomy procedure.

In emphysema, patients suffering from severe hyperinflation undergo bilateral reduction. This procedure reduces the rate of dynamic hyperinflation and also helps improve pulmonary ventilation. Among the alternative methods of surgical treatment of emphysema is the introduction of an umbrella valve into the lungs by bronchoscopy.

Prevention

To prevent shortness of breath, you must adhere to the following rules:

• Avoid all kinds of stress;
• Do not abuse alcohol, quit smoking;
• Try to maintain good physical shape, exercise regularly;
• Do breathing exercises.

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Forecast

The effectiveness of treatment for dyspnea depends on the cause of its occurrence, but the prognosis is usually favorable.

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