DYSPNEA

DYSPNEA

• The American Thoracic Society

– Subjective experience of breathing discomfort that consists of qualitatively distinct sensations
that vary in intensity.
– The experience derives from interactions among multiple physiological, psychological,
social, and environmental factors and may induce secondary physiological and behavioural
responses

• dyspnea: gejala yang bersifat subjektif dan bukan berasal dari peningkatan usaha bernafas
DEFINITION
Difficult, laboured, uncomfortable
breathing. Subjective feeling which may
DYSPNEA be associated with mild anxiety or
extreme fear

HYPERVENTILATION Rapid-deep breathing

TACHYPNEA Rapid-shallow breathing

Sensation of not being able to get

BREATHLESSNESS enough air
MECHANISM

• Respiratory sensations are the consequence of interactions between the efferent i.e. the
motor output from the brain to the ventilatory muscles and the afferent i.e. sensory input
from receptors throughout the body (feedback) which are integrated in the brain.
 MEKANISME
DYSPNEA

EFFERENT-
MOTORIK SENSORIK REAFFERENT EMOSI
MISMATCH
MOTORIK

• Gangguan ventilasi  peningkatan resistensi aliran udara atau kekauan dari system respirasi 
peningkatan work of breathing atau effort untuk bernapas
• Gangguan di otot pernapasan
SENSORIK

• Chemoreceptor
• Mechanoreceptor
• Metaboreceptor
CHEMORECEPTOR
• Chemoreceptor: badan carotid dan
medulla
• Diaktifkan oleh hypoxemia, acute
hypercapnia, and acidemia
• Stimulasi  peningkatan ventilasi  “air
hunger”
• Mechanoreceptor
– Terstimulasi oleh bronchospasm  sensasi chest tightness  aktivasi J-
receptor  ”air hunger”
• Metaboreceptors
– Letak: otot skeletal
– Aktif saat sedang aktivitas dan berhubungan dengan tidak nyaman saat
bernapas
EFFERENT-REAFFERENT MISMATCH

• Mismatch antara afferent – efferent dan respon dari

reseptor yang berperan dalam pernapasan meningkatkan
intensitas dyspnea
EMOSI

• Acute anxiety or fear  meningkatkan keparahan dyspnea

• Altering the interpretation of sensory data or by leading to
patterns of breathing that heighten physiologic
abnormalities in the respiratory system
ASSOCIATION
OF
QUALITATIVE
DESCRIPTORS
&
MECHANISMS
 THE BORG
SCALE
• The Borg Scale is used to
measure your sensation of
breathlessness during various
activities. Monitoring your
breathlessness can help you
safely adjust your activity by
speeding up or slowing down
your movements. It can also
provide important information to
your health care provider.
 DIFFERENTIAL
DIAGNOSIS

RESPIRATORY
CARDIOVASCULAR
SYSTEMS
RESPIRATORY SYSTEM DYSPNEA
• Diseases of the airways
– Astma and COPD
– Characterized by: expiratory airflow obstruction  dynamic hyperinflation of the
lungs and chest wall
– Both lead to hypoxemia and hypercapnia from ventilation-perfusion mismatch
• Diseases of the chest wall
– Kyphoscoliosis, MG, or GBS  ↑effort to breathe
• Diseases of the lung parenchyma
– Arise from: infections, occupational exposures, or autoimmune disorder 
↑stiffness of the lungs and ↑ work of breathing
– V /Q mismatch and the destruction and/or thickening of the alveolar-capillary 
hypoxemia and ↑ drive to breathe
 CARDIOVASCULAR SYSTEM DYSPNEA
• Diseases of the left heart
– CAD and nonischemic cardiomyopathies  greater LV end diastolic volume and an
elevation of the LV end diastolic as well as pulmonary capillary pressure 
interstitial edema and stimulation of pulmonary receptors  dyspnea
• Diseases of the pulmonary vasculature
– Pulmonary thromboembolic disease and primary diseases of the pulmonary
circulation (primary pulmonary hypertension, pulmonary vasculitis)
– Cause dyspnea via increased pulmonary-artery pressure and stimulation of
pulmonary receptors
• Diseases of the pericardium
– Constrictive pericarditis and cardiac tamponade
– Cause increased intracardiac and pulmonary vascular pressures  dyspnea
DYSPNEA WITH NORMAL RESPIRATORY
AND CARDIOVASCULAR SYSTEMS
• Mild – moderate anemia  breathing discomfort during exercise
– Related to stimulation of metaboreceptors
– SpO2 : normal
• Obesity
– Due to multiple mechanisms: high cardiac output and impaired ventilatory pump
function (decreased compliance of the chest wall)
• Cardiovascular deconditioning (poor fitness)
– early development of anaerobic metabolism and the stimulation of
chemoreceptors and metaboreceptors
DYSPNEA SUGGESTING PULMONARY
CAUSE
• Cough with expectoration • Progressive over many years
• Wheezing • Prompt response to Oxygen
• No relation to exertion and
• Fever • Bronchodilators
• Pleuritic chest pain • Seasonal variation
• Loss of wt.
DYSPNEA SUGGESTIVE OF CARDIAC
CAUSE
• PND and orthopnea
• Associated with symptoms of heart disease
• Expectorant pink frothy sputum
• Rapid progression
• Response to diuretics and digoxin
DISTINGUISHING
CARDIOVASCULAR FROM
RESPIRATORY SYSTEM DYSPNEA

• Cardiopulmonary exercise test  to determine

• Peak exercise
– The patient achieves predicted max ventilation,
demonstrates an increase in dead space or hypoxemia,
or develops bronchospasm  respiratory system
– IF the HR is >85% of the predicted max, if he anaerobic
threshold occurs early, if the BP becomes excessively
high or decreases during exercise, if the O2 pulse (O2
consumption/heart rate, an indicator of stroke volume)
falls, or if there are ischemic changes on the
electrocardiogram  cardiovascular system
 PERBEDAAN PPOK DAN ASMA
PPOK ASMA
Onset Biasanya >40 tahun Semua umur, biasanya anak-anak
Riwayat merokok Biasanya > 20 bks/thn (IB 200) Biasanya tidak merokok
Riwayat keluarga Biasanya tidak ada, kecuali Biasanya ada
kekurangan ɑ-antitrypsin
Reversibel saluran napas Tidak reversible penuh, hanya Sangat reversible
reversible sebagian dengan Biasanya fungsi paru hampir normal
bronkodilator
Berhenti merokok dapat mengurangi
penunrunan fungsi paru
Pola gejala Biasanya kronik progresif lambat Bervariasi dari hari ke hari malam/
ridak spesifik menjelang pagi
Batuk (paling menonjol) Dini hari Malam/setelah latihan
Sputum purulen Khas Jarang
Peningkatan IgE Jarang Sering
Eosinofil Jarang Sering