Breathing difficulty – Breathlessness
Breathlessness, also termed as dyspnea is an unpleasant sensation of breathing difficulty or discomfort. In real terms, breathlessness means rapid or difficult breathing either on exertion and activity, or even while resting in the bed. Patients may describe the feeling in different symptoms such as feeling uncomfortable, unpleasant sensation or congestion in the chest, feeling puffed, short of breath or heaviness in the chest, tightening in the chest, air hunger, or a feeling of suffocation. Breathing is essential for survival. Any difficulty in breathing therefore causes anxiety and fear.
Getting breathless following an exercise is normal and the breathing pattern returns to normal after resting. Exercise is a normal physiological cause of rapid breathing. Physiological breathless without the actual disease of heart or lungs can also occur during menstrual periods and pregnancy in women, presence of high fever (of any cause), depression, excessive anxiety and pain. Lack of exercise and increase in weight are also important causes of breathlessness.
Persistent, recurrent and progressive breathlessness may point to the presence of a disease involving most commonly the lungs or the heart. Diseases of blood or other organs can also cause breathlessness either directly or indirectly.
Some of the important diseases causing breathing difficulty include the following:
A. Diseases of the lungs and the respiratory system
- Bronchial asthma – especially in the younger age-groups
- Chronic obstructive pulmonary disease (Chronic bronchitis and emphysema – most commonly in the middle and older age groups especially amongst those who are smokers of cigarettes or bidis)
- Interstitial lung diseases such as hypersensitivity pbeumonias or those with pulmonary fibrosis/ scarring of any cause
- Lung infections such as pneumonias, tuberculosis and fungal infections
- Lung tumours especially cancers of the respiratory system
- Any other lung disease causing destruction of lung tissue
- Pleural diseases such as pleural effusion causing lung compression or pleural thickening causing lung entrapment
B. Diseases of the heart and cardiovascular system
- Cardiac insufficiency of any cause –hypertension and ischemic heart disease heart attack.
- Heart arrhythmia (heart rhythm problems)
- Pulmonary arterial hypertension
- Valvular heart disease due to rheumatic heart disease
- Peri-cardial effusion and Cardiac tamponade (excess fluid around the heart)
- Congenital heart diseases – shunts and valvular stenoses
- Cardio myopathies
- Pulmonary thrombo-embolism
C. Miscellaneous diseases
- Anemia, especially when severe
- Blood cancers
- Any other systemic disease causing insufficiency/ failure of the liver, kidneys or other vital organ systems
- Sleep apnea syndrome
- Diseases of the brain and nervous system, muscles and nerves.
There are several other uncommon causes which can also be responsible for breathlessness. Diagnosis of these conditions can be made only after a detailed clinical work-up and appropriate tests.
Acute episode of breathlessness can occur due to anaphylaxis (a severe allergic reaction), acute asthma, carbon monoxide poisoning, or one of the other above-mentioned causes.
Correct diagnosis is important for an effective management. It is essential to follow an algorithmic approach and undertake investigations directed to look into the possible cause. Detailed clinical history is most essential to pinpoint the origin of the symptom. Routine blood examination and chest x-ray are almost always required. Specialized tests are done following the leads based on initial suspicion and baseline investigations.
Treatment of breathlessness essentially depends on the cause.
Some of the group of drugs which may be temporarily used for management include the painkillers, sedatives (to relieve anxiety), sterile salt water (saline), diuretics and bronchodilator drugs. The use of all such drugs is limited to a short period before one arrives at a specific diagnosis.
- To remove several misgivings, the following important points should always be kept in mind regarding breathlessness:
- Breathlessness is generally considered to be serious when it is accompanied by red-flag signs such as chest pain, fainting, bleeding in sputum, nausea, a bluish tinge to lips or nails, or a change in mental alertness. Some of these signs may point towards a heart attack or pulmonary embolism.
- Oxygen saturation has no direct relationship with breathlessness; Any person can have breathlessness even though when the actual levels of oxygen are within a normal range. Similarly, the pulse oximeter does not show shortness of breath.
- Symptoms of shortness of breath, headache, and confusion or restlessness may occur when the blood oxygen falls below a certain level.
- Over exertion can cause breathlessness but breathlessness which comes on suddenly and unexpectedly may point towards a serious condition.
- Exercises and aerobic activities such as walking, running or jumping rope are good for shortness of breath but should be undertaken under medical advice and supervision in the presence of disease.
For more information visit: Jindal Chest Clinic.
