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
- Pulmonary thromboembolism
- Pulmonary Tuberculosis
- Pulmonary fibrosis
- Respiratory neuromuscular disorders
- Acute left ventricular failure
- Inhaled foreign body
Some special Term
Dyspnoea: difficulty 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:
Activated mast cell eosinofil
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:
- COPD(Chronic Obstructive Pulmonary disease)
- Chronic Bronchitis
- Chronic aspergillosis
- 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
- 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.
- Nebulization by Short acting beta agonist( such as salbutamol)
- Inhaller : short acting beta agonist such as salbutamol.
- long acting beta agonist such as salmetrol,formetrol with fluticasone.
- Injection: hydrocortisone or oral steroid tablet( prednisolone or methylprednisolone).
- Leucotriane antagonist :montelukast and zafrilukast.
- Antihistamine : such as levocetirizine, cetirizine, fexofenadine, ketotofen, ebastine, rupatadine etc.
- Sodium cromoglycate.
- Serum anti-igE such as Omalizumab.