DYSPNEA

Muhammad Fachri

INTODUCTION
Dyspnea:
Discomfort feeling in breathing
Subjective and difficult to measure
Etiology : lung, heart, endocrine, kidney,
neurology, hematology, rheumatology and
psichology
Prevalens of dispnea no accurate data
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DEFINITION OF DYSPNEA
The American Thoracic Society (ATS):

the term of discomfort perception subjective in

breathing that consist of sensation with different
intensity as a results of interaction of various
physiologic, social and environtmental factors.

MECHANISM OF
DYSPNEA
Interaction between signal and
receptor in otonomic nerve
system, motoric cortex,airway
receptor, lung and thoracic cage
dyspnea
4

MECHANISM OF DYSPNEA

MECHANISM OF DYSPNEA
Cognitive
Emotion

Dyspnea

Chemoreceptor
stimulation

Exercise

Complex of breathing

Lung and thoracic cage

Behavior

Primary motoric
cortex

Primary sensoric
cortex

AIRWAY SYSTEM

AIRWAY SYSTEM

MEASURE OF DYSPNEA
Aim : to differentiate the severity and to
evaluate the nature of dyspnea
Technique of measuring :
visual analogue scale
Borg scale
Medical research council (MRC) dyspnea scale
American thoracic sosiety (ATS) dyspnea scale
baseline dyspnea index (BDI)
transitional dyspn index (TDI)

ATS dyspnea index

Grade 1 :
Grade 2 :

Grade 3 :
Grade 4 :
Grade 5 :

No dyspnea except severe

exercise activity
Dyspnea when climb the step
in hurry or climb a small hill
Walk slower compared to
common people
Must stop for breathing after
100 yard walk
Dyspnea while puput on / off
the clothes

Dyspnea
pulmonary

non-pulmonary
(cardiac)

*pulm edema
*arrhythmias
*asthma/COPD
*acute MI
*Pleural effusion
*myocardial ishemia
*pneumonia
*pneumothorax

DYSPNEA IN PULMONARY
DISEASE
Abnormality of breathing mechanism, lung
become more stiff, weakness of ventilation
muscles.
Restrictive lung diseases.
Obstructive lung diseases.
Disturbance of lung diffusion.
Disturbance of lung perfusion.

RESCTIVE LUNG DISEASE

Lung : - atelectasis
- fibrosis
- lung tumour
- bulla
- lung abscess
- pulmonary edema
Mediastinum : - mediastinal tumour
- cardiomegali
- pericardial effusion

RESCTIVE LUNG DISEASE

Pleura : - pleural effusion
- pleural tumour
- pneumothorax
Diaphragm : - hernia of diaphragm
- paralize of diaphragm
Bone : - rib fracture
- pectus excavatum
- scoliosis, kyphosis
Muscle : - miasthenia gravis

ARDS

PNEUMONIA

ATELECTASIS

DESTROYED LOBE

LUNG ABSCES

BULLA

BULLA

MILIARY TB

NODUL IN THE LUNG

LUNG TUMOR

PANCOAST TUMOR

PNEUMOTHORAX

HYDROPNEUMOTHORAX

OBSTRUCTIVE LUNG
DISEASE
Asthma
COPD : - chronic bronchitis
- emphysema
Bronchiectasis
Lung tumour
Foreign body

EMPHYSEMA

Normal

Hyperinflation

Air trapping

BRONCHIECTASIS

BRONCHIECTASIS

BRONCHIECTASIS

BRONCHIECTASIS

BRONCHIECTASIS

BRONCHIECTASIS

BRONCHIECTASIS

Lung Cancer

TUMOR IN THE AIRWAY

LUNG CANCER

DISTURBANCE OF
DIFFUSION

Alveolar wall
Interstitial space
Arterial wall
Plasma
Red blood cell wall

DISTURBANCE OF
PERFUSSION
Pulmonary emboli
Congestive heart failure

Dyspnea
Subjective sensation of:
Difficult, labored breathing or
Shortness of breath

Hyperventilation Syndrome
Response to stress, anxiety
Patient exhales CO2 faster than
metabolism produces it
Blood vessels in brain constrict
Anxiety, dizziness, lightheadedness
Seizures, unconsciousness

Hyperventilation Syndrome
Chest pains, dyspnea
Numbness, tingling of fingers, toes, area
around mouth, nose
Carpopedal spasms of hands, feet

Hyperventilation Syndrome
Treatment
Obtain thorough history
Avoiding misdiagnosis is critical
Try to talk patient down
Re-breathe CO2 from face mask with oxygen
flowing at 1 to 2 liters/minute

Upper Airway

Foreign Body Obstruction

Pharyngeal Edema
Croup
Epiglottitis

Foreign Body Obstruction

Partial or complete
Most common cause of pediatric airway
obstruction

Foreign Body Obstruction

Suspect in any child with
Sudden onset of dyspnea
Decreased LOC

Suspect in any adult who develops

dyspnea or loses consciousness while
eating

Foreign Body Obstruction

Management
Partial with good air exchange
Partial with poor air exchange
Complete

Lower Airway
Asthma
Chronic Obstructive Pulmonary Disease
Chronic bronchitis
Emphysema

Asthma
Reversible obstructive pulmonary disease
Episodic, family history, trigger factor
Younger persons disease (80% have first
episode before age 30)
Lower airway hypersensitive to allergens,
emotional stress, irritants, infection

Asthma
Bronchospasm
Bronchial edema
Increased mucus production, plugging

Resistance to airflow, work

of breathing increase

Asthma
Airway narrowing interferes with
exhalation
Air trapped in chest interferes with gas
exchange
Wheezing, coughing, respiratory distress

Asthma
All that wheezes is not asthma
Other possibilities
Pulmonary edema
Pulmonary embolism
Anaphalaxis (severe allergic reaction)
Foreign body aspiration
Pneumonia

Asthma
Treatment
High concentration O2, humidified
Position of comfort
Assist ventilation as needed
Bronchodilators via small volume nebulizer
Antiinflammatory drugs (e.g. Corticosteroid)
Calm patient, reassure

Chronic Obstructive Pulmonary

Disease
Chronic Bronchitis
Emphysema

Chronic Bronchitis
Chronic lower airway inflammation
Increased bronchial mucus production
Productive cough

Urban male smokers > 30 years old

Chronic Bronchitis

Mucus, swelling interfere with ventilation

Increased CO2, decreased 02
Cyanosis occurs early in disease
Lung disease overworks right ventricle
Right heart failure occurs
Right Heart Failure produces peripheral edema

Blue Bloater

Emphysema
Loss of elasticity in small airways
Destruction of alveolar walls
Urban male smokers > 40-50 years old

Emphysema

Lungs lose elastic recoil

Retain CO2, maintain near normal O2
Cyanosis occurs late in disease
Barrel chest (increased AP diameter)
Thin, wasted
Prolonged exhalation through pursed lips

Pink Puffer

COPD
Prone to periods of decompensation
Triggered by respiratory infections, chest trauma
Signs/Symptoms
Respiratory distress
Tachypnea
Cough productive of green, yellow sputum

COPD Management
Oxygen
Monitor carefully
Some COPD patients may experience
respiratory depression on high concentration
oxygen

Assist ventilations as needed

COPD Management
If wheezing present, aerosol
bronchodilators via nebulizer

Alveolar Function Problems

Pulmonary Edema
Fluid in/around alveoli, small airways
Causes
Left heart failure
Toxic inhalants
Aspiration
Drowning
Trauma

Pulmonary Edema
Signs/Symptoms
Labored breathing
Coughing
Rales, rhonchi
Wheezes
Pink, frothy sputum

Pulmonary Edema
Signs/Symptoms
Sit up
High concentration O2
Assist ventilation

Pulmonary Embolism

Clot from venous circulation

Passes through right heart
Lodges in pulmonary circulation
Shuts off blood flow past part of alveoli

Pulmonary Embolism
Associated with:
Prolonged bed rest or immobilization
Casts or orthopedic traction
Pelvic or lower extremity surgery
Phlebitis
Use of BCPs

Pulmonary Embolism
Signs/Symptoms

Dyspnea
Chest pain
Tachycardia
Tachypnea
Hemoptysis

Sudden Dyspnea + No Readily Identifiable Cause =

Pulmonary Embolism

Pulmonary Embolism
Management
Oxygen
Assisted ventilation
Transport

CONCLUSION

Dyspnea is subjective symptom

Various abnormalities may cause dyspnea
Diagnosis should be establisherd properly
Severity of dyspnea can be measured
Oxygen may be administered initially
Definitive treatment based on the etiology