4- breathlessness + disease

Question 1

what are some reasons people could become breathless?

Answer 1

• heart failure
• asthma
• PE
• anaemic
• hyper-ventilation
• angina equivalent

Question 2

what are 2 ways to categorise breathlessness?

Answer 2

• anatomically -is it problem with muscle, vascular system, overweight affecting diaphragm, brian insult (affecting resp drive), lungs themselves?
• functional - what is underlying problem = oxygen transport, mechanical disadvantage, problem with resp drive centre
  
  • better one

Question 3

what are examples of mechanical restriction causing breathlessness?

Answer 3

• MND = not strong enough muscle
• obesity = carrying extra weight - need higher level of oxygen
• pleural effusion = squashes the lungs
• guillain-Barre = condition of peripheral nerves, they shut down and reach muscles and stop working
• hyperinflation mechanical disadvantage = seen in COPD, like taking half a breath in and breathing up there all the time
• ILD = intrinsic restrictive diseases , lungs stiff and unable to expand

Question 4

what does negative D-dimer rule out?

Answer 4

pulmonary embolism. D-dimer just test to rule something out

Question 5

what is perception of breathing problem causing breathlessness?

Answer 5

can be negative feedback loop which changes breathing pattern →hyperventilation which has high resp rate, tense muscles, high anxiety which keeps driving

Question 6

what are important parts of breathless history?

Answer 6

TIME = onset, duration

severity assessment - what daily activities do they struggle with

exacerbating or relieving factors

associated symptoms

family history

social - occupation, smoking, pets (birds in particular) etc

Question 7

what diseases might fit in if instant breathlessness?

Answer 7

pneumothorax or pulmonary embolism

Question 8

what diseases might fit in if acute (mins-hours) breathlessness?

Answer 8

astma, pneumonia, acute MI, cardiac tamponade

Question 9

what diseases might fit in if sub-acute (days to weeks) breathlessness?

Answer 9

pleural effusion, pulmonary vasculitis, SVCO (superior vena cava obstruction)

Question 10

what diseases might fit in if chronic (months-years) breathlessness?

Answer 10

COPD, ILD, pulmonary hypertension, anaemia

Question 11

what lung function tests can be done for breathlessness?

Answer 11

• spirometry
• body box (measure gas transfer)
• peak flow meter

Question 12

what are imaging tests for breathlessness?

Answer 12

• chest x-ray
• CT scan
• V/Q scan

Question 13

is oxygen uptake the same for everyone?

Answer 13

no - it reaches plato which varies for each person (active people have higher, you can train to improve it)