DYSPNEA

Menaldi Rasmin
Department of Pulmonology and Respiratory Medicine,
Faculty of Medicine, University of Indonesia
Persahabatan Hospital, Jakarta
Diagnosis
Dyspnea:
Discomfort feeling in breathing
Subjective and difficult to measure
Etiology : lung, heart, endocrine, kidney,
neurology, hematology, rheumatology and
psichology
Prevalence of dyspnea no accurate data
INTRODUCTION
1
Diagnosis
VENTILATORY REGULATION
located in the medulla of the brainstem
composed of several subcenters, that interact to
produce rhytmical breathing
output is transmitted to phrenic nerves to diaphragm
and respiratory muscles
affected by
Higher cortical centers
Mechanical
Chemical stimuli
Ventilatory Central Centre
Diagnosis
Cortical Centers
input to the ventilatory center
result; breathing partially under voluntary control
Mechanical reflexes
emanate from skeletal muscle spindle
pulmonary vessels and tissue
Diagnosis
Dyspnea
breathlessness
shortness of breath
uncomfortable or unpleasant
respiratory-related sensation

not tachypnea, not hyperpnea and not hyperventilation
but; difficult, labored, uncomfortable breathing; it is
unpleasant type of breathing though not painful in the
usual sense of the word.
It is subjective and, like pain, it involves both perception
of the sensation by the patient and his reaction to the
sensation
Comroe (1966)
Diagnosis
an uncomfortable awareness of breathing
or an increased respiratory effort that is
unpleasant and regarded as in appropriate
(Mahler et al 1984)
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
Diagnosis
MECHANISM OF DYSPNEA
Interaction between signal and
receptor in otonomic nerve
system, motoric cortex,airway
receptor, lung and thoracic cage
dyspnea

4
Diagnosis
MECHANISM OF DYSPNEA











Dispnea
Komplek pernapasan
Paru & dinding dada
kognitif
perilaku
Emosi
Stimulasi
kemoreseptor
latihan
Kortek motorik primer
Kortek sensorik primer
Dyspnea
Complex of breathing
Lung and thoracic cage
Cognitive
Behavior
Emotion
Chemoreceptor
stimulation
Exercise
Primary motoric cortex
Primary sensoric corte
Diagnosis
MECHANISM OF DYSPNEA

Diagnosis
Diagnosis
Diagnosis
Diagnosis
MEASUREMENT OF DYSPNEA
Aim : to differentiate the severity and to
evaluate the nature of dyspnea
Technique of measurement :
visual analogue scale
Borg scale
Medical Research Council (MRC) Dyspnea
Scale
American Thoracic Sosiety (ATS) Dyspnea
Scale
Baseline Dyspnea Index (BDI)
Transitional Dyspnea Index (TDI)
Diagnosis
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 put on / off
the clothes
Dyspnea

pulmonary non-pulmonary
(cardiac)
*pulm edema *arrhythmias
*asthma/COPD *acute MI
*PE *myocardial ischemia
*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.

RESTRICTIVE LUNG DISEASE
Lung : - atelectasis
- fibrosis
- lung tumour
- bullae
- lung abscess

Mediastinum : - mediastinal tumour
- cardiomegali
- pericardial effusion

Diagnosis
ATELECTASIS
Diagnosis
PANCOAST TUMOR
Diagnosis
LUNG ABSCESS
Diagnosis
Diagnosis
DESTROYED LUNG
Diagnosis
BULLAE
Diagnosis
BULLAE
RESTRICTIVE LUNG DISEASE

Pleura : - pleural effusion
- pleural tumour
- pneumothorax
Diaphragm : - hernia of diaphragm
- paralize of diaphragm
Bone : - rib fracture
- pectus excavatum
- scoliosis, kyphosis
Muscle : - myasthenia gravis
Diagnosis
PLEURAL EFUSSION
Diagnosis
PNEUMOTHORAX
Diagnosis
HYDROPNEUMOTHORAX
OBSTRUCTIVE LUNG DISEASE
Asthma
COPD : - Chronic bronchitis
- Emphysema
Bronchiectasis
Lung tumour
Foreign body
Diagnosis
BRONCHIECTASIS
Diagnosis
LUNG TUMOR
DISTURBANCE OF DIFFUSION
Alveolar wall
Interstitial space
Arterial wall
Plasma
Red blood cell wall
Diagnosis
PNEUMONIA
Diagnosis
ARDS
DISTURBANCE OF
PERFUSSION
Pulmonary emboli
Congestive heart failure
Diagnosis
LUNG NODULES
Diagnosis
MILLIARY TB
Diagnosis
Diagnosis
Diagnosis
Diagnosis
CONCLUSION
Dyspnea is a subjective symptom
Various abnormalities may cause
dyspnea
Severity of dyspnea can be measured
Diagnosis
Diagnosis

Diagnosis
Diagnosis