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

1
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.

3
 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
Behavior
Emotion

Dyspnea
Primary motoric
cortex

Chemoreceptor Primary sensoric

stimulation Complex of breathing cortex

Exercise Lung and thoracic cage

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 : No dyspnea except severe
exercise activity
Grade 2 : Dyspnea when climb the step
in hurry or climb a small hill

Grade 3 : Walk slower compared to

common people
Grade 4 : Must stop for breathing after
100 yard walk
Grade 5 : 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