Breathing difficulty or dyspnea with All about of Asthma : Definition, type, Pathophysiology and Management

Breathing difficulty of a asthma patient and tacking inhellar for relief.

Dyspnoea or shortness of breath or breathing difficulty :

Unable to breath or difficulty getting air in ,or  tiredness .

Cause of Dyspnoea:

  • Bronchial asthma
  • Chronic Obstructive Pulmonary Disease     (COPD)
  • Pleural effusion
  • Pneumonia
  • Pneumothorax
  • Pulmonary thromboembolism
  • Pulmonary Tuberculosis
  • Pulmonary fibrosis
  • Respiratory neuromuscular disorders
  • Anemia
  • Acute left ventricular failure
  • Inhaled foreign body

Some special Term

Dyspnoeadifficulty in breathing.

Orthopnoea : breathlessness when lying flat( eg: left ventricular failure)

Platypnoea : Breathlessness when sitting up with relief on lying down ( eg: patent foramen ovale , ASD)

Paroxysmal nocturnal Dyspnoea Breathlessness that wakes the patient from sleep is typical of asthma and left ventricular failure.

History to Diagnosis:

Onset of Dyspnoea
acute ( asthma, pneumonia,pneumothorax etc)
Chronic ( bronchitis, pulmonary Tuberculosis, lung cancer )

Duration of Dyspnea 

(1)Duration for Minutes ( pulmonary thromboembolism , pneumothorax , asthma , acute left ventricular failure)

(2)Duration for hours to days( pneumonia asthma exacerbation of COPD)

(3) duration for weeks to month ( anaemia , pleural effusion, Respiratory neuromuscular disorders) 

(4) Duration for month to years ( COPD , Pulmonary Tuberculosis, pulmonary fibrosis)

Time worse at night ( asthma)  Worse at morning (COPD)

Relieving factor : aggravated by exposure - cold, dust, pollen , exercise, smoke etc are cause of bronchial asthma . Aggravated by laying position in acute left ventricular failure.
Relieved by lying from sitting up in Atrial septal defect 


Defination: Asthma is an inflammatory conditions  of the airways to the lungs in which your airway may become narrowed and swelling and also produced extra mucuses .
It makes shortness of breath and can make some physical activities challenging or even impossible.

Types  of asthma

  • Bronchial asthma: it is type of asthma cause by airway of the lung narrow and swell.
  • Cardiac  asthma : its a type of coughing and wheezing due left ventricular failure.
  • And Gerd Induced asthma : its type  of asthma which triggered by Gastro Esophageal Reflux  Disease.
  • Allergic asthma : its type  of asthma which triggered by allergen ( pollen, coil, smoke, cold drinks, some foods)
  • Cough variant asthma : it has no breathing difficulty but has chronic dry cough, coughing during exiting, stress etc.
  • Occupational asthma : its type of asthma thats triggered by occupational exposure ( dust, dye,animal dander, fungi and chemical  etc)

Sign and Symptoms  of Asthma :

  • Breathing  difficulty  or shortness  of breath,  worsen at night
  • Crepitation,Wheezing  or whistling sound
  • Chest congestion or thightness
  • First degree  family history
  • Onset from childhood  etc

Pathophysiology  of asthma: 

(Aspirin,exercise, cold air, allergen, dust, propanolol, SO2)


Activated  mast cell eosinofil

Increase  production of arachidonic acid

Increase licotrien mainly( LTC4,LTE4,LTD4) by lipoxygenase pathway
CysL T1 receptor


Plasma  exudation, eosinofil recruitment and bronchoconstriction,mucoussecretion  occur



Laboratory investigation of Asthma :

  • Lung function test( done by spirometry)
  • Peak flow rate
  • Bronchoprovocation test
  • Bronchoallergen test  
  • Complete blood count or full blood count( that show increase neutrofil  count ) 
  • ESR (Erythrocyte sedumentation rate) 
  • Chest X-Ray (AP view) : chest x-ray of Bronchial asthma patients are usually normal but helpful for excluding other illnes such as pneumothorax,pleural effusion etc. 
  • Routine Urine microscopic examination or Urine RME
  • Serum creatinine level
  • Serum electrolyte level      

Differential Diagnosis of Bronchial asthma:

  1. COPD(Chronic Obstructive Pulmonary disease)
  2. Chronic Bronchitis
  3. Bronchiechtesis
  4. Chronic aspergillosis
  5. Pleural Tuberculosis        

Management  of Asthma:

mandatory avoid exposure Stop  smoking Drug used according to registered doctors or MBBS doctors kr general physician.   

Treatment of  Asthma 

  1. Check Blood Oxygen Saturation by Pulse Oximeter as soon as possible if saturation fall below then 93 mmHg, Inhalation Oxygen as soon as possible or reffer to GP or registered Doctors.
  2. Nebulization  by Short acting beta agonist( such as salbutamol) 
  3. Inhaller : short acting beta agonist such as salbutamol. 
  4. long acting beta agonist such as salmetrol,formetrol  with fluticasone.
  5. Injection: hydrocortisone or oral steroid tablet( prednisolone or methylprednisolone).
  6. Leucotriane antagonist :montelukast and zafrilukast.
  7. Antihistamine : such as levocetirizine, cetirizine, fexofenadine, ketotofen, ebastine, rupatadine etc.
  8. Sodium cromoglycate.
  9. Serum  anti-igE such as Omalizumab.

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