Dyspneu

Dyspneu (Gk, Dys = painful / difficult; pneuma = breath)

Dyspneu is a symptoms that alerts individuals when they are in danger of receiving inadequate ventilation; abnormal & uncomfortable awareness of breathing.

Dyspneu may occur when there is :

1. Increased central respiratory drive secondart to hypoxia, hypercapnia, or other afferent input.
   
2. Augmented requirement for the respiratory drive to overcome mechanical constraints or weakness.
   
3. Altered central perception.
   

Modified Borg Category Scale for Rating Dyspnea

0 : nothing at all

0.5 : very, very slight (just noticeable)

1 : very slight

2 : slight

3 : moderate

4 : somewhat severe

5 : severe

6 :

7 : very severe

8 :

9 : very, very severe (almost maximal)

10 : maximal

 

Clinical Assessment in Dyspnea:

1. Duration & onset of breathlessness
   
2. Severity of breathlessness : effects in lifestyle, work, & daily activities
   
3. Exacerbating factors : rest & exertion, nocturnal symptoms, body position.
   
4. Associated symptoms : cough, hemoptysis, chest pain, wheeze, stridor, fever, lost of appetite & weight, ankle swelling, voice change
   
5. Personal & family history of chest disease
   
6. Lifetime employment, hobbies, pets, travel, smoking, illicit drug use, medications.
   
7. Examination of the cardiovascular & respiratory systems
   

Specific Situations

Causes of Breathlessness with normal chest X-Ray :

• Airway disease (asthma, airway obstruction, bronchiolitis)
  
• Pulmonary vascular disease (pulmonary embolism, primary pulmonary hypertension, intrapulmonary shunt)
  
• Early parenchymal disease (e.g. sarcoid, interstitial pneumonias, viral infection)
  
• Cardiac disease (e.g. angina, arrhythmia, valvular disease, intracardiac shunt)
  
• Neuromuscular weakness (e.g. Guillain-Barre syndrome)
  
• Metabolic acidosis
  
• Anemia
  
• Thyrotoxocosis
  
• Hyperventilation syndrome
  

Causes of Episodic / intermittent Breathlessness :

• Asthma
  
• Pulmonary oedema
  
• Angina
  
• Pulmonary embolism
  
• Hypersensitivity pneumonitis
  
• Vasculitis
  
• Hyperventilation syndrome
  

 

Note: Dyspneu in pneumonia caused by inflammation of lung parenchyma from the respiratory bronchioles to the alveoli.