DYSPNEA ...

Dyspnea refers to the sensation of difficult or uncomfortable breathing. It is a subjective experience perceived and reported by an affected patient. Dyspnea on exertion (DOE) may occur normally, but is considered indicative of disease when it occurs at a level of activity that is usually well tolerated. Dyspnea should be differentiated from tachypnea, hyperventilation, and hyperpnea, which refer to respiratory variations regardless of the patients" subjective sensations. Tachypnea is an increase in the respiratory rate above normal; hyperventilation is increased minute ventilation relative to metabolic need, and hyperpnea is a disproportionate rise in minute ventilation relative to an increase in metabolic level. These conditions may not always be associated with dyspnea.

Causes

Most cases of shortness of breath are due to heart or lung conditions. Your heart and lungs are involved in transporting oxygen to your tissues and removing carbon dioxide, and problems with either of these processes affect your breathing.

·         Asthma

·         Carbon monoxide poisoning

·         Cardiac tamponade

·         Heart attack

·         Low blood pressure (hypotension(

·         Pulmonary embolism

·         Pneumonia

·         Pneumothorax

·         Upper airway obstruction

Heart problems

·         Cardiomyopathy

·         Heart arrhythmias

·         Heart failure

·         Pericarditis

Other problems

·         Anemia

·         Broken ribs

·         Choking

·         Epiglottitis

·         Foreign object inhaled

·         Generalized anxiety disorder

·         Guillain-Barre syndrome

·         Myasthenia gravis

In the case of chronic shortness of breath, the condition is most often due to:

·         Asthma

·         COPD — Chronic obstructive pulmonary disease

·         Heart dysfunction

·         Interstitial lung disease

·         Obesity

A number of other health conditions also can make it hard to get enough air. These include:

Lung problems

·         Croup

·         Lung cancer

·         Pleurisy

·         Pulmonary edema

·         Pulmonary fibrosis

·         Pulmonary hypertension

·         Sarcoidosis

·         Tuberculosis

Seek emergency medical care

Call on emergency number or have someone drive you to the emergency room if you experience severe shortness of breath that comes on suddenly and affects your ability to function. Seek emergency medical care if your shortness of breath is accompanied by chest pain, fainting or nausea — as these may be signs of a heart attack or pulmonary embolism.

Blood tests

A number of labs may be helpful in determining the cause of shortness of breath. D-dimer while useful to rule out a pulmonary embolism in those who are at low risk is not of much value if it is positive as it may be positive in a number of conditions that lead to shortness of breath. A low level of brain natriuretic peptide is useful in ruling out congestive heart failure; however, a high level while supportive of the diagnosis could also be due to advanced age, renal failure, acute coronary syndrome, or a large pulmonary embolism.

Imaging

A chest x-ray is useful to confirm or rule out a pneumothorax, pulmonary edema, or pneumonia. Spiral computed tomography with intravenous radiocontrast is the imaging study of choice to evaluate for pulmonary embolism

Self-care

To help keep chronic shortness of breath from getting worse:

·         Stop smoking. The benefits of quitting smoking are extraordinary. Once you're tobacco-free, your risks of heart disease, lung disease and cancer begin to drop — even if you've been smoking for years.

·         Avoid exposure to pollutants. As much as possible, avoid breathing allergens and environmental toxins.

·         Lose weight if you are overweight.

·         Take care of yourself. If you have an underlying medical condition, take care of it.

·         Have an action plan. Discuss with your doctor what to do if your symptoms become worse.

·         Avoid exertion at elevations higher than 5,000 feet (1,524 meters)

·         If you rely on supplemental oxygen be sure your supply is adequate and the equipment works properly.