Dyspnea

Retno Ariza

Definition
Abnormally

breathing

uncomfortable awarness of

Intensity quantified
Sensation

Normal

breathing : respiratory rate about 14

20/mnt (adult), up to 44 (infant)
Bradypnea : slow breathing (causes as
coma,drug induced respiratory depression)
Tachypnea : rapid shallow breathing
(restrictive lung disease)

Abnormally of rhythm of breathing

Cheyne-Stokes

breathing : periods of deep

breathing alternate with periode apnea (brain
damage)
Kussmaul breathing : rapid deep breathing has
causes metabolic acidosis
Biots breathing : ataxic breathing is
characterized by unpredictable irregularity.
Breaths may be shallow or deep, and stop for
short periods (respiratory depression and brain
damage)

American Thoracic Society

Shortness of Breath Scale
0

(none) no troubled by shortness of

breath when hurrying on the level or
walking up a slight hill
1(mild) troubled by shortness of breath
when hurrying on the level or walking up a
slight hill
2(moderate)walk slower than people of the
same age on the level because of
breathlessness or has to stop for breath
when walking at own pace on the level

American Thoracic Society

Shortness of Breath
3(severe)

stop for breath after walking

about 100 yard or after a few minutes on
the level
4(very severe) too breathless to leave
the house or breathless on dressing or
undressiing

Cause
Chest

wall

Renal

Pleura

Hematology

Neuromuscular

Rheumatohologic

Lung

Psychiatric

disease
Heart disease
Metabolic system

disorder
Endocrine changes
(pregnancy)

History taking of dyspnea

Acute (Asthma, MCI, pneumonia, CHF), chronic

(respiratory distress from muscular dystrophy)
Nocturnal dypnea : Asthma, CHF,gastroesophageal
reflux,nasal congestion
Supine position : pregnancy, acites,diaphragmatic
paralysis
Symptoms are intermittent (reversible disease) :
asthma, CHF,COPD
Symptoms appear with somethink induced
(smoke,allergen) : asthma

Lung disease
Airway

obstruction

Extrathoracic

airways to lung periphery

Upper airway obstructrion inspiratory
stridor & retraction of supraclavicular fossae
Intrathoracic obstruction asthma
Diffuse

parenchymal lung disease

Pulmonary embolism

Heart disease
pulmonary capillary pressure
Fatigue of respiratory muscles
Exertional breathlessness orthopnea
paroxymal nocturnal dyspnea

Others
Disease

of the chest wall or respiratory

muscles
Severe

kyphoscoliosis
Spinal deformity
Bilateral diaphragmatic paralysis

Other objective testing in the

evaluation of dyspnea
After

complete history & physical

examination determine of the system
Respiratory

system
Cardiovascular system
Metabolic disturbance, musculosceletal ect
Choice

the objective testing

Respiratory

infection : hematology
(leucocyte,diff count), Blood gas analysis, x
ray

 Resiratory

obstruction :Pulmonary Function

Test (spirometry)
Malignancy in respiratory system :
broncoscopy, CT Scan
CVS : EKG,ECHO
Metabolic : Blood sugar, BGA, renal function
test,ect

Peak flow meter

Spirometry

Bronchoscopy

Radiology

Radiology

Pleura Space

To use M D I

Nebulizer