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Dyspnoea


Dyspnoea is the subjective awareness of breathing discomfort.

Causes

Sudden (seconds to minutes)

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    Pneumothorax ( Fig. 15 )

    Figure 15, A pneumothorax, visible on the right side .

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    Chest trauma

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    Aspiration

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    Pulmonary oedema

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    Pulmonary embolism

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    Anaphylaxis

Acute (hours to days)

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    Asthma

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    Respiratory tract infection

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    Pleural effusion

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    Lung tumours

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    Metabolic acidosis

Chronic (months to years)

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    Chronic airflow limitation (COPD)

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    Anaemia

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    Arrhythmia

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    Valvular heart disease

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    Cardiac failure

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    Cystic fibrosis

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    Idiopathic pulmonary fibrosis

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    Chest wall deformities

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    Neuromuscular disorders

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    Pulmonary hypertension

History

Many cardiac or respiratory diseases of sufficient severity produce dyspnoea. When considering chronic respiratory causes, you may relate them anatomically to diseases of the pulmonary vasculature, airways, interstitium and chest wall. When approaching a patient with dyspnoea, it is important to ensure that the ABCs are attended to before continuing with the diagnostic process.

Onset

The speed of onset is a useful indicator of the disease process. Classification by speed of onset narrows the differential diagnosis in urgent clinical situations.

Precipitating factors

An obvious precipitating factor may be present, such as trauma causing either fractured ribs or a pneumothorax. Aspiration of a foreign body may be determined from the history; however, aspiration of vomit is more difficult, as it usually occurs in patients with decreased consciousness levels or who have lost the gag reflex. Dyspnoea on recumbency is caused by cardiac failure; occasionally, patients may complain of waking up at night gasping for breath (paroxysmal nocturnal dyspnoea). Dyspnoea associated with asthma may be associated with particular allergens, e.g. grass pollen, house dust mites. A history of severe allergy should lead to the consideration of anaphylaxis. Stressful events can precipitate asthma attacks but may also cause anxious patients to hyperventilate.

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