What is dyspnea (shortness of breath)? Causes, symptoms and treatment

10 March 2019   |    17 June 2019   |   Category: Internal Diseases
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Dyspnea (shortness of breath) is often described as an intense tightening in the chest, air hunger or a feeling of suffocation. Very strenuous exercise, extreme temperatures, massive obesity and high altitude all can cause shortness of breath in a healthy person. Outside of these examples, shortness of breath is likely a sign of a medical problem often related to heart or lung disease. If you experience recurrent, sudden, or severe dyspnea, you should see a doctor. You may need medical intervention, and your treatment will depend on the underlying cause of your shortness of breath. If you have unexplained shortness of breath, especially if it comes on suddenly and is severe, emergency assistance should be requested.

What is dyspnea?

Breathing is normally done unconsciously, unnoticed. The person is not expected to feel the breathing of a person, except for heavy exercise. However, respiratory activity continues to be troublesome and if the person is aware of this, dyspnea can be considered. These problems are usually expressed by the patients as chest tightness, air hunger and being breathless.

The definition and degree of shortness of breath can vary according to person, region and culture. Shortness of breath may develop in minutes, hours and days as well as may develop slowly in weeks and months.

Causes of shortness of breath

The oxygen that the person needs is taken from the air passes through the nose to the lungs, then in the lung passes to the blood and reaches to the heart. It disperses into the tissues and organs in the body through the arteries emerging from the heart.

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All these events is regulated by the brain. Shortness of breath develops in any disease or disorder that prevents oxygen reaching to the tissues. Causes of shortness of breath can be classified in 3 categories as: lung, heart and other non-cardiac

Lung-induced shortness of breath

Oxygen cannot pass into the bloodstream due to a disease in the lung. Diseases that may cause this condition include:

  • COPD
  • Asthma
  • Pneumonia
  • Pulmonary embolism
  • Atelectasis
  • Lung cancer
  • Pleural effusion (fluid accumulation in the lung membrane)
  • Inhalation of a foreign object

Heart related shortness of breath

In heart disorders, the heart cannot pump blood-rich blood into the body and non-pumped blood accumulate in the lung over time and prevents the passage of oxygen into the blood which resulting in shortness of breath. Heart related shortness of breath usually occurs when lying down, get back to the normal in sitting position.

The most common heart disorders causing shortness of breath:

  • Heart failure
  • Heart attack
  • Cardiac tamponade (accumulation of fluid around the heart).

Other reasons

  • Anemia: Decrease in oxygen-carrying cells may cause dyspnea.
  • Respiratory muscle retention due to muscle diseases: Breathing muscles in the breathing process allows to breathe and relax. Shortness of breath occurs in diseases such as myasthenia gravis, where muscles are affected.
  • Obesity: Due to the lungs cannot expand sufficiently, shortness of breath occurs.
  • Psychological reasons
  • Acute mountain sickness: As the elevation is higher, the oxygen pressure and air density decreases, so air hunger and shortness of breath are felt.

Symptoms of shortness of breath (dyspnea)

  • Fast and superficial breathing
  • Tightness in the chest
  • Air hunger
  • Feeling suffocated
  • Cyanosis (pale or blue face, mouth, lips, or extremities)
  • Wheezing
  • Palpitations
  • Intermittent speech due to shortness of breath
  • Headache, dizziness, weakness

The above symptoms may not be in every shortness of breath or may be accompanied by more than one. Symptoms of shortness of breath may vary depending on the underlying disease.

How to understand shortness of breath

It is difficult to define the quantity and quality of breathlessness as everyone describes it differently. If there is shortness of breath in very simple daily activities, this is the most advanced level of dyspnea. You must consult a doctor in for further examination.

Shortness of breath and cough

Cough is a defense mechanism that protects lungs by throwing away the foreign and harmful objects, excessive secretion of the lungs. In patients with pneumonia, pulmonary embolism and heart failure, dyspnea and cough can be seen together. In addition, pulmonary exacerbation after severe coughing may cause shortness of breath.

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Diagnosis of shortness of breath

Shortness of breath is not a disease; is a symptom of any disease. A person with shortness of breath should be examined and diagnosed. With a good medical history and physical examination, the cause of the disease can be understood. Blood tests and imaging methods are used when necessary.

  • Medical History: The duration, character, time of day, other complaints (cough, chest pain, etc.), the positions and situations in which it decreases or increases, the causes that trigger the symptoms are questioned as well as concomitant illnesses, drugs used, smoking status.
  • Physical examination: Fever, respiratory rate, blood pressure and heart rate are evaluated first.The lungs are listened with a stethoscope if heart beats are rhythmical, there are additional sounds and decreased or abnormal breathing sounds may be heard. In patients with heart failure, swelling of the legs can be seen and veins become apparent.
  • Pulse Oximeter: It attaches to the fingertip or earlobe and provides information on the oxygen saturation of the blood.
  • Blood tests: Blood gas is taken to clearly show the level of oxygen and carbon dioxide in the artery.. A complete blood count test is performed to demonstrate anemia and infection.

Imaging methods

  • Pulmonary function test (PFT): known as “FT breath test” among the population. It is a non-invasive test commonly used in the diagnosis of lung diseases.
  • Bronchoscopy: It is a process of imaging the airways and lungs by entering through nose with a thin pipe with a camera. It can be used both for diagnosis and treatment. If necessary, a sample piece of tissue can be taken from the airways and lungs.
  • Chest radiography – Computer tomography: It gives information about breathing tube, lung and heart shortness.
  • Electrocardiogram (ECG): Heart rate, rhythm, signs of inadequate blood and oxygen flow to heart muscle, symptoms of previous heart attacks can be diagnosed with ECG.
  • Echocardiography (ECO): Heart ultrasound. Indicates whether there is movement disorder in the heart walls due to heart muscle tissue death. Gives information for heart failure
  • Angiography: Angiography uses paint and special x-rays to show the inside of your arteries. A thin, flexible tube, called a catheter, is inserted into a blood vessel in the arm, inguinal or neck. With this method, the doctor can see the blood flow in the veins. Used for diagnosis and treatment.

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Treatment of shortness of breath

Treatment can be done in three ways: support, treatment and surgical treatment.

Dyspnea oxygen therapy

If the oxygen level of the patient with dyspnea is low, oxygen treatment is given during the investigation of the cause. Depending on the needs and tolerances of the patient, can be given through the nose or with mask through the mouth and nose. It should be given with caution in patients with COPD because they will suppress breathing and increase carbon dioxide. Long-term oxygen therapy should be used for at least 16 hours a day, at home during night.

Positive pressure ventilation

In advanced dyspnea, “non-invasive positive pressure ventilation” method is applied. Positive compressed air is given to the patient to facilitate breathing with a face mask. Goal is to rest the tired respiratory muscles.

Drug treatment of shortness of breath

  • Bronchodilator drugs: It provides bronchial expansion. This eases the air flow so that the person can breathe easily. Salbutamol and ipratropium are used for sudden dyspnea, formoterol, salmeterol and tiotropium are used for continuous control of the disease. There may be side effects such as tremors, palpitations.
  • Anti-inflammatory drugs: They are steroid-derived drugs that suppress inflammation and used to control diseases such as asthma and COPD. Fluticasone, budesonide, methylprednisolone are among these. Cough, bone resorption, blood sugar and blood pressure may have side effects such as.
  • Diuretics: They are used to remove excessive fluid from the body through urine in cases such as heart failure and fluid accumulation in the lung.
  • Antibiotics: Used to treat lung and respiratory tract infections.

Shortness of breath surgery

In atelectasis, it is ensured that the air leak is closed by attaching the tube to the lung. If there is cancer in the lungs or airways, surgery can be performed. Bypass surgery can be performed in heart attack. In severe heart and lung failure, heart and lung transplantation can be considered.

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What is good for shortness of breath?

You need to shape the physical characteristics of your living environment to reduce dyspnea:

  • Choose a large room seeing outside and a cool environment. You can open the window to cool the environment or use a fan at a low setting.
  • Wash your face. The cold stimulation applied to the face has been shown to reduce the perception of dyspnea through facial sensory nerve by lowering the heat on the skin surface.
  • Wear comfortable clothing that will not tighten the chest.
  • Try to live a life free of stress. Relaxing music or massages can help.

Shortness of breath exercises and correct breathing techniques

Practicing breathing exercises and the right techniques will relax the patient.

  • Pursed-lip breathing: Especially the patients with COPD can exhale by puckering their lips to be able to exhale the air trapped in their lungs and prolong exhalation process.
  • Sit leaning forward: It is used to prevent pressure on the lung and heart and to breathe easily by using the effect of gravity.
  • Comfortable sleep position: In patients with heart failure and low blood pressure, the level is increased by placing a pillow under the foot to prevent blood ponding in vein. Multiple pillows should be used to avoid shortness of breath when sleeping at night.
  • Diaphragmatic breath: Breathe in slowly through your nose so that your stomach moves out against your hand. The hand on your chest should remain as still as possible. Place one hand on your upper chest and the other just below your rib cage. This will allow you to feel your diaphragm move as you breathe. Tighten your stomach muscles, letting them fall inward as you exhale through pursed lips. The hand on your upper chest must remain as still as possible.
  • Strength training: Patients with shortness of breath may have muscle weakness due to immobility and underlying disease. It is designed to improve all muscles of the body, exercise capacity and quality of life. Bike riding, stair climbing, walking, aerobic exercises and electrical stimulation can increase muscle strength.
  • Postural drainage: This method is an airway clearance technique that helps people with COPD clear mucus from their lungs.
  • Energy saving techniques: It is aimed to reduce energy consumption during work and daily activities. Customized programs are made. The patient is informed about the importance of asking for help from family and ending unnecessary activities. With the landscaping, materials to be used by patient should be placed where they can reach.

How to recover shortness of breath?

People with shortness of breath should consult a doctor first. When the cause of the disease is found and treated, shortness of breath will also spontaneously dismiss. Diseases such as COPD may not recover completely. In these cases, the patient is tried to be relieved by controlling dyspnea. In cases of shortness of breath as a result of high climbing; if acute mountain sickness develops, should be climbed down to lower ground, rested and, if necessary, medicated.

Herbal treatment of shortness of breath

  • Eucalyptus oil: It is dropped into boiling water. Upper airway blockages can be opened by pulling the steam through the nose. It should not be used in overdose, allergy should be taken into consideration. You should consult your doctor before use.
  • Protein: Patients with shortness of breath require more energy when breathing compared to normal people. To meet this energy need, they should be fed with a high calorie diet with high protein content.
  • Vitamin D: If shortness of breath depends on COPD, vitamin D levels will be low. Thus, foods such as milk, eggs and salmon, which have a high content of vitamin D, should be consumed.
  • Omega-3: Protects against heart disease by reducing triglyceride. Foods such as salmon, tuna, walnuts, hazelnuts and flaxseed contain omega-3. Foods such as beans, melons, broccoli and cabbage, which make breathing difficult by increasing the air in the stomach, should be reduced. Patients with heart failure should limit their consumption of water and salt.

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What is psychological dyspnea?

It is shortness of breath without any underlying cause. This diagnosis should not be made without research in order not to overlook the underlying diseases that may cause shortness of breath. The results of all tests performed in psychological dyspnea are normal.

Causes and symptoms of psychological shortness of breath?

It can be seen in diseases such as anxiety disorders, panic disorder, and post-traumatic stress disorder. These patients express their dyspnea as “I have difficulty breathing deeply, I can’t get enough air into my lungs, and I’m suffocating”.

Symptoms are:

  • Chest pain
  • Excitement due to chest pain, palpitation caused by fear
  • Inhaling style breathing
  • Due to the air hunger, getting into the vicious circle by breathing quickly.
  • No shortness of breath at night
  • Shortness of breath does not occur after typical trigger factors.
  • Symptoms occur suddenly and in rest.
  • They can talk in a very comfortable way with long sentences.

Physiological dyspnea during pregnancy

Changes in the uterus and hormonal changes during pregnancy also affect the respiratory system. During pregnancy, 60-70% of women have dyspnea expressed as air hunger. Gradually increasing frequently observed in the second trimester (13-27 weeks). Although the mechanism is unknown, it is thought to be caused by progesterone hormone.

Lung examination findings are normal, additional symptoms such as cough are not accompanied. The diagnosis is being made by excluding other factors.

Recommendations for patients with shortness of breath

  • Stay away from conditions and environments that increase dyspnea (dirty, dusty environments or substances that trigger asthma attacks).
  • Lose weight.
  • Create a schedule with your doctor to show you what you should do when you develop emergency dyspnea and what medication you should take.
  • Treatment compliance is important because shortness of breath can be prolonged. Be sure to follow the doctor’s recommendations and follow the controls regularly.
  • Know side effects of the drugs you are using in your treatment and how to avoid these side effects. Always consult a doctor if you experience an unexpected side effect.
  • Stop smoking. If you find it difficult to quit, get support from smoking cessation clinics.
  • Get pneumonia vaccines and flu vaccines every year to prevent lung and respiratory infections.
  • Participate in respiratory rehabilitation programs. Rehabilitation reduces the patient’s complaints, improves his / her psychological status and helps the person to participate in society.
  • Your daily life activities may be affected by shortness of breath. Therefore, you may feel depressed. You can get support from your surroundings and psychologists.
  • If you have an oxygen device at home, use it regularly according to the doctor’s recommendation. Since the oxygen device works with electricity, always keep an oxygen cylinder in the house against power cuts.
  • To avoid shortness of breath due to high altitude, you should rest every 2-3 days during climbing or at least 1 day at 1000 meters. Make the climb slow. Do not climb more than 300 meters per day above 3000 meters in particular.
  • Shortness of breath can be a sign of important diseases. If you feel shortness of breath, you should consult a doctor even if it passes by itself.

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