Lack of air when breathing - causes, methods of diagnosis and treatment

How does tachypnea manifest?

At rest, a person with tachypnea takes about 60 or more breaths per minute, while a healthy person breathes about 16-18 times per minute. This is a type of inspiratory dyspnea in which the patient does not have other clinical signs, for example, blue lips or a certain body position. Rapid breathing is the result of hyperventilation , which occurs due to a decrease in carbon dioxide in the blood. The amplitude of respiratory movements decreases, and the human body suffers from hypoxia . The arteries contract, and the volume of blood that circulates throughout the human body decreases. As a result, the body experiences a deficiency of oxygen.

Tachypnea is often observed in various diseases, which are accompanied by other characteristic symptoms. However, when diagnosing some pathological conditions, tachypnea is considered the most characteristic symptom. This applies, for example, to manifestations of pulmonary embolism . During hysteria, the patient's breathing rate can reach up to 60-80 times per minute (the so-called “dog breathing”). Tachypnea is a symptom that resembles shortness of breath . But with tachypnea, breathing is shallow, and no changes in its rhythm are noted.

With manifestations of tachypnea, the content of carbon dioxide in the blood decreases due to hyperventilation. This phenomenon is called hypocapnia and is manifested by severe dizziness and sometimes fainting. Treatment of tachypnea is always associated with manifestations of the underlying disease.

Causes of shortness of breath

Shortness of breath, a feeling of lack of air can be associated with disturbances in external (oxygen supply through the lungs) or internal (tissue) respiration:

• Impact on the respiratory center of toxins, metabolic products in severe infectious diseases.
• Respiratory impairment due to exposure to toxic chemicals at the cellular level.
• Chest injuries that violate the tightness of the pleural cavities; compression of the lungs with pneumothorax, hydrothorax.
• Neurological complications in multiple sclerosis, myasthenia, functional and neurotic breathing disorders in hysteria, neurasthenia, etc.
• Blockage of the airway lumen with viscous secretion (with bronchitis, bronchial asthma), tumor, foreign body (button, food, vomit).
• Swelling and thickening of the bronchial wall, spasm of the bronchial muscles of an allergic or inflammatory nature in bronchial asthma, pneumonia, etc.
• Heart failure, in which there is stagnation of blood in the vessels of the pulmonary circulation, effusion of fluid into the alveoli of the lungs, a decrease in the vital capacity of the lungs, and a decrease in peripheral blood flow.
• Coronary heart disease, when the main symptom of insufficient blood supply to the myocardium is shortness of breath.
• For anemia as a result of decreased hemoglobin levels and a decrease in the number of red blood cells due to blood loss; in case of poisoning with certain chemicals that bind hemoglobin.
• Obesity and physical detraining can also cause shortness of breath with minimal physical activity.

Intense exercise, extreme temperatures, obesity, and high altitude can all cause shortness of breath in a healthy person. Outside of these examples, dyspnea is a sign of a medical problem. If you experience unexplained breathing problems, especially if they occur suddenly, you should consult a doctor immediately.

Why does tachypnea occur?

Rapid breathing is associated with excitation of the respiratory center, which occurs in connection with the pathology of the central nervous system, or occurs reflexively.

In a normal state, a person's breathing rate depends on a number of factors. It is necessary to take into account the congenital characteristics of the body, body weight, physical activity of a person, his general health, age, etc. Tachypnea can be associated with different human conditions. For example, rapid breathing during pregnancy and rapid breathing during fever are often observed.

Rapid, shallow breathing is a very important criterion for diagnosing diseases in a child who cannot yet independently complain of a certain ailment. For example, rapid breathing during sleep in a child may indicate that his body temperature has risen.

One of the reasons for the manifestation of such a disorder is a stressful situation. The person breathes very quickly, it is difficult for him to speak, and heaviness in the legs may appear. After such an attack, similar to a panic attack, the person suffers from a headache. Later, rapid breathing may occur during sleep.

Tachypnea develops in hysteria . During such attacks, a person breathes approximately like a hunting dog. In addition to rapid breathing, a patient with hysterical neurosis experiences attacks of rage, instability of emotions, etc.

Very often, rapid breathing in children and adults is associated with colds. Sometimes tachypnea indicates bronchial asthma , and intensifies before the onset of an asthma attack.

Rapid breathing with attacks of wet cough in the morning may be a sign of chronic bronchitis . If a person with tachypnea experiences chest pain when trying to take a deep breath, they may have pneumonia . Rapid breathing is also observed with pleurisy . With tuberculosis, rapid shallow breathing is combined with coughing, poor appetite, weakness, and elevated body temperature. Sometimes tachypnea indicates that a person has diseases of the cardiovascular system.

Parents often notice rapid breathing in their child. Young parents who notice rapid breathing in their newborn are especially worried about this. In this case, the child may alternate between deep and shallow breaths, and uncharacteristic sounds appear when breathing. In most cases, all these manifestations do not indicate pathologies. In a baby, rapid breathing is due to the fact that his airways are small, and a lot of air constantly passes through them. In addition, the respiratory tract and organs are not yet fully developed. Therefore, rapid breathing in a baby is very often observed in the first month of his life, and as the child grows, breathing becomes deeper and less frequent. A longer period for breathing to adjust is needed for children who were born prematurely and with very little weight. Parents must understand that tachypnea in children is vital for saturating the body with oxygen. Therefore, a newborn baby can breathe 40-50 times in one minute.

In addition to these causes of tachypnea, there are a number of natural causes that can provoke increased breathing. This is serious physical and emotional stress, a state of stress. Rapid breathing can occur as a side effect after taking certain medications or using stimulants. Tachypnea in pregnant women is the result of hormonal changes and changes in the anatomical features of the body during the period of bearing a child.

Neurogenic respiratory disorders: hyperventilation syndrome

History of the study of hyperventilation syndrome (HVS). The first clinical description of HVS was by Da Costa (1842), who summarized his observations of soldiers participating in the Civil War. He observed breathing disorders and various associated unpleasant sensations in the heart area, calling them “soldier’s heart”, “irritable heart”. The connection between pathological symptoms and physical activity was emphasized, hence another term - “effort syndrome”. In 1918, Lewis proposed another name, “neurocirculatory dystonia,” which is still widely used by therapists. Manifestations of HVS such as paresthesia, dizziness, and muscle spasms have been described; a connection between increased breathing (hyperventilation) and muscular-tonic and tetanic disorders has been noted. Already in 1930, it was shown that pain in the heart area with Da Costa syndrome is not only associated with physical activity, but also with hyperventilation as a result of emotional disturbances. These observations were confirmed during the Second World War. Hyperventilation manifestations were noted in both soldiers and civilians, which indicated the importance of psychological factors in the genesis of HVS.

Etiology and pathogenesis. In the 80–90s of the twentieth century, it was shown that HVS is part of the structure of the psychovegetative syndrome [1]. The main etiological factor is anxiety, anxiety-depressive (less often, hysterical) disorders. It is mental disorders that disrupt normal breathing and lead to hyperventilation. The respiratory system, on the one hand, has a high degree of autonomy, on the other, a high degree of learning ability and a close connection with the emotional state, especially anxiety. These features underlie the fact that HVS is in most cases of psychogenic origin; extremely rarely it is caused by organic neurological and somatic diseases - cardiovascular, pulmonary and endocrine.

Complex biochemical changes play an important role in the pathogenesis of HVS, especially in the calcium-magnesium homeostasis system. Mineral imbalance leads to an imbalance in the respiratory enzyme system and contributes to the development of hyperventilation.

The habit of breathing incorrectly is formed under the influence of cultural factors, past life experiences, as well as stressful situations suffered by the patient in childhood. The peculiarity of childhood psychogenies in patients with HVS is that they often involve respiratory dysfunction: children witness dramatic manifestations of attacks of bronchial asthma, cardiovascular and other diseases. In the past, patients themselves often have an increased load on the respiratory system: running, swimming, playing wind instruments, etc. In 1991, I. V. Moldovanu [1] showed that with HVS there is instability of breathing, a change in the ratio between the duration of inspiration and exhale.

Thus, the pathogenesis of HVS appears to be multilevel and multidimensional. A psychogenic factor (most often anxiety) disrupts normal breathing, resulting in hyperventilation. An increase in pulmonary and alveolar ventilation leads to stable biochemical changes: excessive release of carbon dioxide (CO2) from the body, the development of hypocapnia with a decrease in the partial pressure of CO2 in the alveolar air and oxygen in the arterial blood, as well as respiratory alkolosis. These shifts contribute to the formation of pathological symptoms: impaired consciousness, autonomic, muscular-tonic, algic, sensory and other disorders. As a result, mental disorders increase and a pathological circle is formed.

Clinical manifestations of HVS. HVS can be paroxysmal in nature (hyperventilation crisis), but more often hyperventilation disorders are permanent. HVS is characterized by a classic triad of symptoms: respiratory disorders, emotional disturbances and muscular-tonic disorders (neurogenic tetany).

The first are represented by the following types:

• "empty breath";
• violation of breathing automaticity;
• labored breathing;
• hyperventilation equivalents (sighs, coughing, yawning, sniffling).
• Emotional disorders are manifested by feelings of anxiety, fear, and internal tension.

Muscular-tonic disorders (neurogenic tetany) include:

• sensory disturbances (numbness, tingling, burning);
• convulsive phenomena (muscle spasms, “obstetrician’s hand”, carpopedal spasms);
• Chvostek syndrome II–III degree;
• positive Trousseau test.

In the first type of respiratory disorder - “empty breath” - the main sensation is dissatisfaction with inhalation, a feeling of lack of air, which leads to deep breaths. Patients constantly lack air. They open the vents and windows and become “air maniacs.” Respiratory disorders intensify in agoraphobic situations (subway) or social phobia (exam, public speaking). Breathing in such patients is frequent and/or deep.

In the second type - a violation of the automaticity of breathing - patients have a feeling of stopping breathing, so they continuously monitor the act of breathing and are constantly involved in its regulation.

The third type - shortness of breath syndrome - differs from the first option in that breathing is felt by patients as difficult and performed with great effort. They complain of a “lump” in the throat, failure of air to pass into the lungs, and constriction of breathing. This variant is called "atypical asthma." Objectively, increased breathing and irregular rhythm are noted. The act of breathing uses the respiratory muscles. The patient looks tense and restless. Examination of the lungs does not reveal any pathology.

The fourth type - hyperventilation equivalents - is characterized by periodically observed sighs, coughing, yawning, and sniffling. These manifestations are sufficient to maintain prolonged hypocapnia and alkalosis in the blood.

Emotional disturbances in HVS are mainly of an anxious or phobic nature. The most common disorder is generalized anxiety disorder. It, as a rule, is not associated with any specific stressful situation - the patient experiences various mental (feelings of constant internal tension, inability to relax, anxiety over trifles) and somatic manifestations for a long time (more than 6 months). Among the latter, respiratory disorders (usually “empty breath” or hyperventilation equivalents - coughing, yawning) may form the core of the clinical picture - along with, for example, algic and cardiovascular manifestations.

Respiratory disturbances reach a significant degree during a panic attack, when a so-called hyperventilation crisis develops. Disorders of the second and third types are more common - loss of automatic breathing and difficulty breathing. The patient experiences a fear of suffocation and other symptoms characteristic of a panic attack. To diagnose a panic attack, four of the following 13 symptoms must be observed: palpitations, sweating, chills, shortness of breath, suffocation, pain and discomfort in the left side of the chest, nausea, dizziness, a feeling of derealization, fear of going crazy, fear of death, paresthesia, waves heat and cold. An effective method for relieving a hyperventilation crisis and other symptoms associated with respiratory failure is breathing into a paper or plastic bag. In this case, the patient breathes his own exhaled air with a high content of carbon dioxide, which leads to a decrease in respiratory alkalosis and the listed symptoms.

Agoraphobia is often the cause of HVS. This is fear that arises in situations that the patient regards as difficult to help him. For example, a similar condition can occur in the subway, store, etc. Such patients, as a rule, do not leave home unaccompanied and avoid these places.

A special place in the clinical picture of HVS is occupied by an increase in neuromuscular excitability, manifested by tetany. Tetanic symptoms include:

• sensory disorders in the form of paresthesia (numbness, tingling, crawling, buzzing, burning sensations, etc.);
• convulsive muscular-tonic phenomena - spasms, contractions, tonic convulsions in the hands, with the phenomenon of “obstetrician’s hand” or carpopedal spasms.

These manifestations often occur in the picture of a hyperventilation crisis. In addition, increased neuromuscular excitability is characterized by Chvostek's symptom, a positive Trousseau cuff test and its variant, the Trousseau-Bahnsdorff test. The characteristic electromyographic (EMG) signs of latent muscle tetany are essential in the diagnosis of tetany. An increase in neuromuscular excitability is caused by the presence in patients with HVS of a mineral imbalance of calcium, magnesium, chlorides, and potassium, caused by hypocapnic alkalosis. There is a clear connection between increased neuromuscular excitability and hyperventilation.

Along with the classic manifestations of HVS, paroxysmal and permanent, there are other disorders characteristic of the psychovegetative syndrome as a whole:

• cardiovascular disorders - pain in the heart, palpitations, discomfort, chest compression. Objectively, lability of pulse and blood pressure, extrasystole are noted, and on the ECG - fluctuation of the ST segment; acrocyanosis, distal hyperhidrosis, Raynaud's phenomenon;
• disorders of the gastrointestinal tract: increased intestinal motility, belching of air, bloating, nausea, abdominal pain;
• changes in consciousness, manifested by a feeling of unreality, lipothymia, dizziness, blurred vision, in the form of fog or a grid before the eyes;
• algic manifestations, represented by cephalgia or cardialgia.

So, to diagnose hot water supply, confirmation of the following criteria is necessary:

1. The presence of polymorphic complaints: respiratory, emotional and muscular-tonic disorders, as well as additional symptoms.
2. Absence of organic nervous and somatic diseases.
3. Presence of psychogenic history.
4. Positive hyperventilation test.
5. Disappearance of symptoms of hyperventilation crisis when breathing into a bag or inhaling a mixture of gases (5% CO2).
6. Presence of tetany symptoms: Chvostek's sign, positive Trousseau test, positive EMG test for latent tetany.
7. Change in blood pH towards alkalosis.

Treatment of hot water supply

Treatment of hot water supply is comprehensive and is aimed at correcting mental disorders, teaching proper breathing, and eliminating mineral imbalances.

Non-drug methods

1. The essence of the disease is explained to the patient, they are convinced that it is curable (the origin of the symptoms of the disease, especially somatic ones, and their relationship with the mental state are explained; they are convinced that there is no organic disease).
2. It is recommended to quit smoking and drink less coffee and alcohol.
3. Breathing exercises are prescribed to regulate the depth and frequency of breathing. To carry it out correctly, several principles must be observed. First, switch to diaphragmatic abdominal breathing, during which the “inhibitory” Hering-Breuer reflex is activated, causing a decrease in the activity of the reticular formation of the brain stem and, as a result, muscle and mental relaxation. Secondly, maintain certain relationships between inhalation and exhalation: inhalation is 2 times shorter than exhalation. Thirdly, breathing should be rare. And finally, fourthly, breathing exercises should be carried out against the background of mental relaxation and positive emotions. At first, breathing exercises last for several minutes, then for quite a long time, forming a new psychophysiological breathing pattern.
4. For severe hyperventilation disorders, breathing into a bag is recommended.
5. Autogenic training and breathing-relaxation training are shown.
6. Psychotherapeutic treatment is highly effective.
7. Among the instrumental non-drug methods, biofeedback is used. The feedback mechanism with the objectification of a number of parameters in real time allows you to achieve more effective mental and muscle relaxation, as well as regulate your breathing pattern more successfully than with autogenic training and breathing-relaxation training. The biofeedback method has been successfully used for many years in the Clinic of Headache and Autonomic Disorders named after. acad. A. Veina for the treatment of hyperventilation disorders, panic attacks, anxiety and anxiety-phobic disorders, as well as tension headaches.

Medicinal methods

Hyperventilation syndrome refers to psychovegetative syndromes. Its main etiological factor is anxiety, anxiety-depressive and phobic disorders. Psychotropic therapy has priority in its treatment. In the treatment of anxiety disorders, antidepressants are more effective than anxiolytic drugs. Patients with anxiety disorders should be prescribed antidepressants with pronounced sedative or anxiolytic properties (amitriptyline, paroxetine, fluvoxamine, mirtazapine). The therapeutic dose of amitriptyline is 50–75 mg/day; to reduce side effects: lethargy, drowsiness, dry mouth, etc., the dose should be increased very slowly. Selective serotonin reuptake inhibitors have better tolerability and fewer unwanted side effects. The therapeutic dose of fluvoxamine is 50–100 mg/day, paroxetine is 20–40 mg/day. Their most common unwanted side effects include nausea. To prevent it or more successfully overcome it, it is also recommended to prescribe the drug at half the dosage at the beginning of therapy and take it with meals. Given the hypnotic effect of fluvoxamine, the drug should be prescribed in the evening; Paroxetine has less pronounced hypnogenic properties, so it is often recommended to take it with breakfast. The four-cyclic antidepressant mirtazapine has a pronounced anti-anxiety and hypnotic effect. It is usually prescribed at bedtime, starting with 7.5 or 15 mg, gradually increasing the dose to 30–60 mg/day. When prescribing balanced antidepressants (without pronounced sedative or activating effects): citalopram (20–40 mg/day), escitalopram (10–20 mg/day), sertraline (50–100 mg/day), etc., their combination is possible for a short period of 2–4 weeks with anxiolytics. The use of such a “benzodiazepine bridge” in some cases makes it possible to accelerate the onset of action of psychotropic therapy (this is important, given the delayed effect of antidepressants by 2-3 weeks) and to overcome the increase in anxiety symptoms that temporarily arise in some patients at the beginning of therapy. If the patient has hyperventilation crises during an attack, along with breathing into the bag, anxiolytics should be taken as abortive therapy: alprazolam, clonazepam, diazepam. The duration of psychotropic therapy is 3–6 months, if necessary up to 1 year.

Psychotropic drugs, along with a positive therapeutic effect, also have a number of negative properties: unwanted side effects, allergization, development of addiction and dependence, especially to benzodiazepines. In this regard, it is advisable to use alternative means, in particular, means that correct mineral imbalance, which is the most important symptom-forming factor in hyperventilation disorders.

As agents that reduce neuromuscular excitability, drugs that regulate calcium and magnesium metabolism are prescribed. The most commonly used are ergocalciferol (vitamin D2), Calcium-D3, as well as other medications containing calcium for 1–2 months.

The generally accepted view is that magnesium is an ion with clear neurosedative and neuroprotective properties. Magnesium deficiency in some cases leads to increased neuro-reflex excitability, decreased attention, memory, convulsive attacks, impaired consciousness, heart rhythm, sleep disorders, tetany, paresthesia, and ataxia. Stress - both physical and mental - increases the need for magnesium in the body and causes intracellular magnesium deficiency. A state of stress leads to depletion of intracellular magnesium reserves and its loss in the urine, since an increased amount of adrenaline and norepinephrine promotes its release from cells. Magnesium sulfate has been used in neurological practice for a long time as an antihypertensive and anticonvulsant. There are studies on the effectiveness of magnesium in the treatment of the consequences of acute cerebrovascular accident [2] and traumatic brain injury [4], as an additional remedy for epilepsy, and the treatment of autism in children [3, 7].

Magne B6 contains magnesium lactate and pyridoxine, which additionally potentiates the absorption of magnesium in the intestine and its transport into cells [6]. The implementation of the sedative, analgesic and anticonvulsant effects of magnesium-containing drugs is based on the property of magnesium to inhibit excitation processes in the cerebral cortex [5]. Prescribing Magne B6 both as monotherapy, 2 tablets 3 times a day, and in complex therapy in combination with psychotropic drugs and non-drug treatment methods, leads to a decrease in the clinical manifestations of HVS.

For questions regarding literature, please contact the editor.

E. G. Filatova, Doctor of Medical Sciences, Professor of MMA named after. I. M. Sechenova, Moscow

How to get rid of tachypnea?

If a person experiences frequent attacks of rapid breathing that are not associated with natural causes, and there is general weakness, pain and discomfort in the chest, dry mouth, a feeling of panic and other symptoms, it is imperative to consult a specialist. In this case, tachypnea is most likely associated with the development of a specific disease, and treatment of tachypnea is carried out as part of the treatment of the underlying disease. Depending on the causes of tachypnea, you should contact a pulmonologist, allergist, cardiologist, psychiatrist or other specialists.

To provide short-term relief from rapid breathing, you can use a regular paper bag, which helps to optimize the gas balance in the human blood. You need to squeeze the edges of the bag with one hand and use the finger of your other hand to make a hole in the bag for breathing. You need to put the bag to your mouth and breathe slowly and evenly into it, inhaling and exhaling the air that is in it.

You need to breathe into this bag for 4-5 minutes. If after such a session there is no restoration of normal breathing rhythm, you must consult a doctor.

To get rid of attacks of tachypnea during stress, you need to practice special breathing exercises that allow you to relax.

Diagnostic stages

Consultation with a therapist. The doctor will conduct a thorough examination of the patient and ask him about accompanying symptoms. If necessary, he will refer the patient to other specialists at our hospital - a cardiologist, hematologist, and psychotherapist.

Laboratory diagnostics

:

• general blood analysis;
• blood chemistry.

Instrumental diagnostics

:

• spirography
• ECG;
• ECHO-KG
• Chest CT scan or radiography.

Additional examination

, the volume of which is determined individually depending on the direction of the diagnostic search.