DYSPNEA

Allen Widysanto
MAJOR SYMPTOMS OF
PULMONARY DISEASE
DEFINITION
Difficult, laboured, uncomfortable
breathing. Subjective feeling which may
DYSPNEA be associated with mild anxiety or
extreme fear

HYPERVENTILATION Rapid-deep breathing

TACHYPNEA Rapid-shallow breathing

Sensation of not being able to get

BREATHLESSNESS enough air
ETIOLOGY
LUNG HEART MUSCULOSCELETAL

DYSPNEA

METABOLIC KIDNEY BRAIN

PULMONARY DYSPNEA
OBSTRUCTION

RESTRICTION
VENTILATION
IMPAIRMENT
IMPAIRMENT OF
OXYGEN TRANSFER
DIFFUSION
SHUNTING
PERFUSION ANEMIA
INADEQUATE
CARDIAC OUTPUT
SIGNS AND SYMPTOMS
Depend on the causa
UPPER AIRWAY OBSTRUCTIONS ARE CHARACTERIZED BY
STRIKING INSPIRATORY STRIDOR, INSPIRATORY WHEEZING

LARYNGEAL OR
TRACHEAL
OBSTRUCTION
HOW TO DIAGNOSE?
SHORT HISTORY TAKING
PHYSICAL EXAMINATION

CONSCIOUSNESS
EFFORT OF BREATHING : torakoabdominal or
abdominotorakal
VITAL SIGN :
BLOOD PRESSURE, RESPIRATORY RATE, HEART RATE
GENERAL EXAMINATION
Cyanosis,,cuping hidung, pursed lip breathing,
retraction, cold
SPECIFIC EXAMINATION
decrease vesicular, stridor, wheezing
IS SHORTNESS OF BREATH REALLY
HAVE TO BE WORRIED?

YES OR NO
NO :
1. trigger point.
Trigger points in the muscles of the throat, neck,
chest, and back may also interfere with the nervous
systems control of respiration.
2. Bad breathing habit
Shallow breathing
YES
HAS ANOTHER SYMPTOMS RATHER THAN SOB ALONE
ONSET of BREATHLESSNESS
SUDDEN
ONSET

Pulmonary embolus A few hour

Pneumotoraks
Inhalation of a foreign body
Asthma
Over days or
Pulmonary edema weeks

Accumulation of PE GRADUAL
Partial/complete airway occlusion ONSET OVER
due to growth of lung cancer MONTHS OR YEARS

COPD
Lung fibrosis
Non-respiratory causes
(anemia, hyperthyroidism)
MANAGEMENT STRATEGIES

Decreasing the central drive to breathe

Reducing the sense of effort or improve respiratory muscle function

Altering the central perception of dyspnea

Decreasing central drive to breathe

Oxygen
Opiates
Anxiolytics
 Reduce the sense of effort and
improve respiratory muscle function
Hyperinflation as a primary mechanism of dyspnea : breathing
techniques and changing breathing paterns for reducing dyspnea.
The patient should be allowed to get the most convenient position
until she/he experiences the least shortness of breath
NISV
Pursed lip breathing

Help the patient to maintain a slow, rhythmic and deep pattern of breathing
Alter the central perception of dyspnea
When acute dyspnea persists despite optimal treatment, care
focuses on the symptom rather than the disease.
Breathing-relaxation training
Counseling and support
Distraction with music
Acupunture /acupressure
Chest wall vibration
Neuro-electrical muscle stimulation
COMPLICATION

RESPIRATORY
FAILURE

Inability of the respiratory system to maintain a normal state of gas exchange

from the atmosphere to the cells as required by the body = To maintain
normal arterial blood PO2, PCO2 and pH
 TREATMENT
Supplemental oxygen
Bronchodilators
Diuretics
Antibiotics
Mechanical ventilation

THE UNDERLYING DISEASE LEADING TO

RESPIRATORY FAILURE MUST BE ADDRESSED
4 take home messages
Dyspnea = Shortness of breath is one of the major symptoms
of pulmonary disease which is giving sensation such as
uncomfortable breathing .
There are many etiologies of shortness of breath either from
the lung or the other organs.
Management of dyspnea is depend on the underlying disease,
however supplemental oxygen is a must.
Respiratory failure ( type 1 or type 2 ) is the complication of
unmanaged shortness of breath.