Professional Documents
Culture Documents
Arimbi )
Dyspnea
Regulated not only by automatic centers located in the brainstem but also
by voluntary signals initiated in the cortex.
Sensations arising from respiratory activity affect the rate and pattern of
breathing as well as the individual's functional status. Derangements in
the respiratory controller, ventilatory pump, or gas exchanger may
underlie uncomfortable breathing sensations, generally referred to as
dyspnea by clinicians. While the initial goal of clinicians when treating a
patient who is dyspneic is to remedy the physiologic derangement
producing the sensation, there are many individuals with chronic
cardiopulmonary disorders for which the underlying pathophysiology
cannot be corrected.
Definitions
Dyspnea is the term generally applied to sensations experienced by
individuals who complain of unpleasant or uncomfortable respiratory
sensations. Many definitions of dyspnea have been offered, including:
"difficult, labored, uncomfortable breathing" (22), an "awareness of
respiratory distress" (23), "the sensation of feeling breathless or
experiencing air hunger" (24), and "an uncomfortable sensation of
breathing" (7). These definitions have sometimes mixed the true
symptom (what patients say they are feeling) with physical signs (what
the physician observes about the patient, e.g., "exhibits labored
breathing"). In the final analysis, a symptom can only be described by
the person who experiences it. In this context, recent investigations of the
perception of breathlessness suggest that there are multiple types of
dyspnea (3).
Respiratory Control System
The respiratory control system functions to satisfy the metabolic
requirements of the body. Respiratory motor activity emanates from
clusters of neurons in the medulla. Efferent respiratory discharges
activate the ventilatory muscles that expand the chest wall, inflate the
lungs, and produce ventilation. The resulting breathing regulates the