Shortness of breath - causes, diagnosis and treatment

general characteristics

Dyspnea is perceived by patients as a subjective feeling of lack of air, ineffectiveness of breathing movements, and tightness in the chest.
The symptom is accompanied by characteristic objective signs: increased or slower inhalations and exhalations, pallor or cyanosis of the nasolabial triangle, convulsive loud inhalation, suffocation. Often, to alleviate the condition, a person with dyspnea stops moving, takes a forced position - sits on a chair or bed, leans forward a little, leaning on straight arms. Most often, the appearance of shortness of breath is associated with physical exertion, and at the beginning of the disease the disorder is provoked only by significant activity, and as it progresses, patients feel a lack of air after normal activities. In addition to respiratory disorders, pathological symptoms are possible: pain and discomfort in the chest, headache, dizziness, decreased performance. If shortness of breath is observed when performing usual work or at rest, you should consult a specialist.

How to assess lung function after coronavirus?

A breath test should be performed. You can do it yourself at home:

take a deep breath through your nose,
hold your breath for ten seconds,
exhale slowly.

In the absence of any discomfort, cough or sore throat, the lungs are healthy. If your health worsens and these symptoms occur, you should immediately seek medical help. You can find a video on the forum on how to properly do a lung assessment.

Development mechanism

Shortness of breath is caused by a variety of complex reflex mechanisms involving higher nervous structures, so there are several theories of its development. Many doctors cite changes in oxygen and carbon dioxide levels in the blood as the immediate cause of impaired breathing frequency and quality. An increase in the concentration of carbon dioxide, leading to a decrease in pH, has a significant stimulating effect on the bulbar centers, peripheral chemoreceptor zones of the arteries and central receptors located in the medulla oblongata.

At the same time, protective mechanisms are activated, the respiratory center of the brain stem sends activating impulses to the bronchopulmonary system, causing a pathological increase in breathing. The appearance of shortness of breath is associated with impulses from the fusiform nerve endings of the respiratory tract, which are activated as a result of various pathological processes. Sometimes increased work of the respiratory center is observed during descending cortical influences caused by hysterical or neurotic conditions.

The connection of the symptom with the temperature of the internal environment of the body has been proven. With hyperthermia, the sensitive areas of the respiratory center are washed with warmer blood, which causes their activation - so-called thermal shortness of breath occurs. A decrease in body temperature, on the contrary, leads to a decrease in respiratory movements. The development of dyspnea is influenced by the amount of muscle load and metabolic level. Most researchers believe that this mechanism is due to two types of reactions - slow humoral and fast neurogenic.

Subjective sensations in the form of lack of air and suffocation are primarily associated with the spread of excessive excitation from the centers of the medulla oblongata to the limbic structures and the cerebral cortex. This causes the appearance of negative emotional reactions of fear and anxiety in patients with shortness of breath. Sometimes unpleasant symptoms develop due to a discrepancy between the body's needs for ventilation and the functionality of the breathing apparatus to provide it.

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.

Classification

Dyspnea can manifest itself in many diseases and pathological conditions, so to facilitate the diagnostic search it is necessary to accurately determine its type. The classification of the symptom is based on the mechanism of development, the degree of change in respiratory function, and the ratio of the inhalation-exhalation phases. There are physiological shortness of breath, when the frequency of inhalations and exhalations changes in proportion to physical activity, and pathological. Most often the symptom is classified in relation to the respiratory phases:

Inspiratory dyspnea
. This type of disorder is manifested primarily by difficulty in the inhalation phase. Dyspnea is detected in diseases of the diaphragm and pleura, heart failure, and pulmonary fibrosis. Dyspnea in combination with noisy breathing is typical for pathologies of the trachea and large bronchi.
Expiratory dyspnea
. The symptom is usually observed when the patency of small bronchi and bronchioles is impaired, typical of bronchial asthma. Shortness of breath on exhalation also occurs with chronic obstructive bronchitis, pneumosclerosis, and decreased elasticity of the lung tissue as a result of emphysema.
Mixed dyspnea
. Respiratory failure in both phases often develops in severe stages of heart failure and progressive diseases of the respiratory system. This type of dyspnea can be associated with feverish conditions, pathologies of the central nervous system with direct irritation of the respiratory center.

Taking into account changes in respiratory function, several types of shortness of breath are distinguished: tachypnea - an increase in the frequency of breaths more than 40 per minute, bradypnea - a decrease in respiratory movements less than 12 per minute, apnea - a sudden stop in breathing. There is a classification of the symptom according to the main mechanism of development: central dyspnea is observed with organic or functional changes in the functioning of the respiratory center in the medulla oblongata, the neurogenic version is associated with a weakening of inhibitory influences in the cerebral cortex, the hemic form develops with anemia.

Psychogenic asthma

In general, bronchial asthma refers to a pathology of the respiratory system. Its development is associated with changes in the structure of the bronchi against the background of immune failures, that is, it is a very specific disease, the etiology of which is not related to mental factors.

People suffering from this disease may develop a condition called psychogenic asthma. This happens when attacks of suffocation, the main symptom of the disease, are provoked by nervous overstrain, both positive and negative, whereas in normal cases this occurs under the influence of cold, infections or physical exertion.

Under the influence of super-emotions, histamine is released. This is one of the main mediators of inflammation. It causes bronchospasm. The result is a dry cough, shortness of breath and an attack of suffocation.

Psychogenic asthma often develops in women during the menstrual period and in children, whose psyche is still quite unstable and very sensitive.

Causes of shortness of breath

Causes of lack of air

A subjective feeling of difficulty in inhaling can be observed in healthy people after intense physical exertion, and in pregnant women. Pathological causes of the symptom are various disorders in the functioning of the respiratory and other body systems. Lack of air is caused by:

Lung diseases
: lobar and interstitial pneumonia, tuberculosis, sclerotic processes and primary amyloidosis.
Pleurisy
: dry, exudative, hemorrhagic.
Respiratory tract damage
: foreign bodies of the trachea, bronchi, thoracic injury, pulmonary hemorrhage.
Causes from the larynx
: false croup, laryngomalacia, neuropathic paresis.
Tumors
: pleural cancer, bronchioloalveolar cancer, invasive thyroid cancer.
Acute conditions
: cardiac asthma during heart attacks, heart defects, pulmonary embolism.
Neuroses
: panic attack, vegetative-vascular dystonia, cardioneurosis.

Causes of difficulty exhaling

Expiratory shortness of breath with convulsive short inhalation and prolonged exhalation is often a sign of various diseases of the bronchopulmonary system. The symptom is often accompanied by a feeling of tightness in the chest. Difficulty in exhalation manifests itself in the following pathological conditions:

Bronchial asthma
: allergic, mixed, occupational.
Obstructive damage to the respiratory tract
: bronchitis and COPD, bronchiectasis, tracheal and bronchial stenosis.
Pulmonary pathology
: pneumosclerosis, emphysema, deficiency of the enzyme alpha1-antitrypsin.
Occupational diseases
: byssinosis, gasoline pneumonia.
Complications of pharmacotherapy
: taking NSAIDs (especially aspirin), infusions of blood or plasma with a high content of citrates.
Rare causes
: Williams-Campbell syndrome, Mendelssohn syndrome, tumors in the tracheal bifurcation area.

Characteristic symptoms

Shortness of breath with coronavirus: how to understand ? It is difficult for the patient to take a deep breath. He makes at least twenty respiratory movements, which is typical for the moderate severity of the disease. As for the severe degree, it is characterized by more than thirty respiratory movements per minute.

At the same time, severe inflammatory processes occur in the lungs: a person’s body temperature rises, but in some situations, shortness of breath with coronavirus without fever , a dry cough is bothersome. But in some cases there may be no symptoms. Then the cough is caused by fear and panic.

If pneumonia is present, during auscultation the doctor hears whistling and wheezing in the bronchi. This is often typical for patients with concomitant bronchial asthma, chronic bronchitis and in the presence of secondary lung damage. Subsequently, if treatment is not timely, edema of the pulmonary tissue may develop - this is a life-threatening condition.

Diagnostics

Patients with complaints of shortness of breath or difficulty in exhaling seek help from a pulmonologist or local physician. The diagnostic search involves conducting laboratory and instrumental studies of the respiratory system and functional tests. The most informative ways to clarify the cause of shortness of breath are:

Assessment of external respiration
. Spirometry is a non-invasive and accessible method of research, during which the main parameters of the respiratory system are recorded - vital capacity of the lungs, forced expiratory volume in the first second. A bronchodilation test is indicated to differentiate between COPD and asthma.
X-ray examination
. Performing an X-ray of the chest organs in 2 projections allows us to detect typical pathological changes (diffuse sclerosis, emphysema, space-occupying formations), which usually cause shortness of breath. Further examination involves the use of computed tomography and MRI.
Laryngoscopy
. To identify narrowing of the lumen of the larynx and visualize foreign bodies, the mucous membranes are examined using a special laryngoscope. In the absence of signs of damage, laryngoscopy is complemented by tracheobronchoscopy for a detailed study of the structure of the bronchial tree with the collection of material for cytomorphological examination.
Electrocardiography.
An ECG is performed to exclude cardiac causes of shortness of breath. If the results are questionable, the cardiovascular system is examined in an expanded format: phonocardiography and cardiac ultrasound with Doppler ultrasound are prescribed. In case of possible periodic disturbances, Holter monitoring is used.
Lab tests
. Assessing blood oxygen saturation and carbon dioxide levels is necessary to determine the degree of respiratory distress. A general blood test may show signs of inflammatory processes (increased ESR, leukocytosis). A biochemical blood test is also recommended.

To identify the etiological factor of shortness of breath, allergy tests are performed; the results of an extended immunogram are informative. If suspicious formations are detected on radiographs, a transbronchial lung biopsy is performed. To diagnose rare congenital defects as a possible cause of dyspnea, specialized specialists are involved.

Inhaled bronchodilators are used to quickly relieve shortness of breath

How to understand that you need a doctor's help

It is not always possible to independently determine the causes of shortness of breath during exercise or at rest. A pulmonologist will help with this; you should make an appointment with him if you experience shortness of breath and have trouble breathing . In case of an acute sudden attack with a significant deterioration in well-being, the patient needs emergency help. If you are concerned about shortness of breath and lack of air without exercise , then you need to visit a doctor as planned.

Treatment

Help before diagnosis

If an attack of shortness of breath suddenly begins, the patient must be calmed down, seated on a chair or bed so that the torso is in an elevated position. To make breathing easier, it is advisable to remove tight clothes, a belt, and unbutton your shirt collar. It is necessary to ensure the flow of fresh air into the room - open a window or door. The use of herbal sedatives is allowed. Frequent occurrence of breathing difficulties indicates the development of a disease or the progression of existing diseases. In such a situation, it is necessary to consult a doctor as soon as possible.

Conservative therapy

The treatment regimen is selected individually, taking into account the cause of dyspnea. An important place in the treatment of chronic conditions accompanied by shortness of breath is occupied by lifestyle correction: quitting smoking, regularly performing a special set of physical exercises. In case of hypoxemia, oxygen therapy sessions are performed. Etiotropic, pathogenetic and symptomatic drug therapy with drugs from the following groups is indicated:

Bronchodilators
. Short-acting beta-agonists in the form of inhalers are used to quickly relieve attacks of shortness of breath. Long-term β2-agonists, methylxanthines, are used as basic therapy.
Expectorants
. Medicines are effective for chronic bronchitis and COPD. They stimulate the discharge of sputum and improve the permeability of the bronchial tree. In some cases, expectorant drugs are combined with mucolytics.
Antibiotics.
Antimicrobial agents are prescribed for acute and chronic inflammatory damage to the respiratory tract caused by bacterial microflora. When choosing an antibacterial drug, the results of sputum culture are taken into account.
Cardiotonics
. To reduce shortness of breath in patients suffering from heart disease, cardiac glycosides are used. Pre- and afterload on the myocardium is reduced with the help of peripheral vasodilators and diuretics.
Corticosteroids
. In case of severe respiratory disorders, taking hormonal medications on an ongoing basis is indicated. In patients with bronchial asthma, inhaled forms of glucocorticoid hormones are effective.
Cytostatics
. Courses of chemotherapy with antitumor drugs are recommended for patients with malignant neoplasms of the lungs and bronchi. To enhance the effect, drug treatment is supplemented with radiation therapy.

Prognosis and prevention

Dyspnea does not fall into the category of systemic diseases. This is a sign of the development of cardiac or pulmonary pathology. The problem can only be dealt with by treating the underlying disease. With dystrophic changes as a result of the development of cardiac pathologies, survival rate decreases to 60%. Only early diagnosis and timely treatment can guarantee a favorable outcome.

To relieve the symptoms of shortness of breath or for prevention purposes, it is recommended to adhere to the following rules:

Perform simple exercises to train the respiratory system and increase muscle tone, unless there are contraindications.
Avoid contact with allergens that may worsen the condition.
Prevent seasonal infections.
Stop smoking.
Control body weight.

The main condition for preventive measures is strict compliance with all recommendations of the attending physician.

Shortness of breath may make it difficult to eat. Here are some practical tips for saving energy and getting the most out of your food:

eat in small portions;
try to breathe calmly and evenly while eating;
Frozen convenience foods, ready-made meals, or take-out and delivery can make life easier;
it is recommended to limit the amount of products that cause gas formation;
You can keep a food diary to determine which foods worsen your overall condition.

In some cases, acupressure and/or acupuncture can help. Before deciding to prescribe procedures, you should definitely consult your doctor. Both practices focus on stimulating hot spots to optimize energy flow and release blockages.

Dyspnea at rest is a rare phenomenon that accompanies severe and advanced diseases. This phenomenon usually appears during physical activity. Pay attention to whether you have difficulty breathing when climbing stairs or walking quickly. If you notice a lack of oxygen, be sure to make an appointment with your doctor for consultation.

Symptoms

Hyperventilation syndrome is a disease that occurs in crises. The symptoms of the syndrome appear quite unexpectedly and very powerfully, while the symptoms after a certain period of time cease to bother you until the next attack. As a rule, symptoms bother patients from several minutes to 1-2 hours.

A hyperventilation crisis begins with fear and unreasonable anxiety, which are simultaneously accompanied by a feeling of lack of air, a lump in the throat, the inability to take a full breath, and shortness of breath. These symptoms can appear simultaneously with fear and anxiety, or come with a slight delay. As a rule, symptoms progress and patients are overcome by a new fear - the fear of death. Next, disturbances occur in the cardiovascular system, such as high blood pressure, rapid pulse, chest pain, and so on. Fear gradually develops into panic. Often other symptoms appear, which can be divided into 5 groups:

Autonomic symptoms are manifested by urinary disorders, cardiovascular, respiratory and gastrointestinal disorders;
Motor and muscle-tonic disorders;
Clouding of consciousness;
Mental disorders;
Sensory organ disturbances, pain.

Let's consider each identified group of symptoms separately.

Urinary disorders

As a rule, this disorder worries patients closer to the end of the crisis. Patients produce a large amount of urine, urinate frequently, and the color of the urine becomes light, close to transparent.

Cardiovascular disorders

During hyperventilation crises, disturbances in the cardiovascular system occur quite often. Their list includes:

Chest compression, pain;
Feeling every heartbeat;
Stitching, aching, squeezing or shooting pain in the heart;
Heart rhythm disturbances;
Pressure surges;
Feeling of discomfort in the heart area;
Raynaud's syndrome;
Excessive sweating;
Blue discoloration of feet and hands;
Hearing impairment, noises in the head;
Headache;
Changes in ECG;
Unsteady gait;
Dizziness.

Respiratory disorders

Respiratory disorders are an obligatory “guest” during a hyperventilation crisis. Violations along this line have the following symptoms:

Lack of air;
Feeling of empty breath;
Excessive concentration on the breathing process.

Patients often complain that they want to take as deep a breath as possible, but no matter how hard they try, this is not possible. As a rule, such patients during a crisis have a normal rhythm of exhalation and inhalation, and the breathing itself is deep and rapid. The reason for dissatisfaction with your breathing in this case is a crisis stressful situation, in which all sensations intensify significantly.

Patients often complain that they simply cannot stop making efforts to take each breath: it seems to them that if they stop their efforts, they will stop breathing altogether.

When patients cannot take a full breath due to the presence of obstacles such as a tight chest or a lump in the throat, they prefer to concentrate all their attention on what is preventing full breathing. Patients try to cope with the “obstacle”, finding the cause of difficulty breathing solely in themselves. As a rule, such patients breathe extremely quickly, making enormous efforts for each inhalation and exhalation with muscle tension, which do not take part during quiet breathing. Breathing becomes frequent and unrhythmic. In some ways, these symptoms of a hyperventilation crisis resemble the symptoms of asthma.

Frequent symptoms are sniffling, yawning, coughing and sighing, repeated frequently and, again, for no reason. They usually do not cause discomfort or fear in patients, but they affect the gas composition of the blood and disrupt its acidity. These symptoms are not relevant for the crisis state of hyperventilation syndrome.

Gastrointestinal disorders

In the vast majority of cases, hyperventilation syndrome is accompanied by disturbances in the functioning of the gastrointestinal tract. The list of symptoms includes:

Vomit;
Rumbling in the stomach;
Bloating;
Belching;
Constipation or diarrhea.
Abdominal pain;
Intolerance to foods that were previously digested normally.

Motor and musculo-tonic disorders

In 9 out of 10 cases, hypertensive crises are accompanied by these disorders, which are represented by the following disorders:

Trembling in the arms and legs, most often with a feeling of cold or heat;
Chvostek's sign (excessive readiness of muscles to contract);
Carpopedal spasm (the foot bends, the fingers are folded in such a way as if the patient were taking a pinch of salt).

Changes in consciousness

Symptoms of changes in consciousness include the following:

Mild blindness, blurriness, fog in the eyes, darkening;
Presyncope;
Fainting;
The feeling that familiar events never happened and, conversely, events unknown to the patient are allegedly repeated;
Loss of personality, expressed in the patient’s thoughts regarding his reincarnation (depersonalization);
Loss of reality, expressed in the feeling of being in an unreal world: a film, a fairy tale, and so on (derealization).

Mental disorders

At the time of a hyperventilation crisis, the mental state of patients deteriorates significantly, but it does not indicate insanity and does not cause inappropriate behavior. Mental disorders are manifested by the patient's current thoughts and experiences. Symptoms along this line include:

Sadness;
Yearning;
Fears;
Anxiety;
Unreasonable worries;
An overreaction to any situation.

Sensory organ disturbances, pain

Hyperventilation syndrome in a state of crisis always leads to pain and causes sensory disturbances. Symptoms along this line are extremely varied. The most popular symptoms are:

Burning, tingling, sensation of “goosebumps”;
Numbness of the limbs and parts of the body (usually the hands and face, the rest - less often);
Feelings of advancing paralysis;
Distinct pain in the head, stomach, heart and other parts of the body and organs;
Pain with every convulsive contraction of the muscles.

2.When is shortness of breath normal?

Although shortness of breath is always an unpleasant condition, it should only be a concern in cases where it indicates a disorder in the body. If a person has been exposed to physical exertion, experienced stress, or found himself in an extreme situation, shortness of breath is a physiological norm

and is in the nature of a compensatory mechanism. Rapidly climbing stairs, intense swimming, and lifting heavy objects cause rapid breathing even in the healthiest person. However, normally, after transitioning to a calm state, breathing should quickly recover, without causing a feeling of lack of air.

If shortness of breath occurs disproportionately to the impact received (during normal walking, when rushing, from a sharp sound, after bending over, lifting a heavy object once), this may indicate somatic diseases, infections, psycho-emotional or endocrine disorders.

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