Breathlessness Flashcards
What is breathlessness?
Dyspnoea
- A highly subjective, uncomfortable or distressing sensation that occurs when actual ventilation is perceived not to satisfy demand
What are the (3) different types of breathlessness?
- Acute
- Subacute
- Chronic
How quickly does acute breathlessness occur?
Suddenly/within minutes
How quickly does subacute breathlessness occur?
Over hours/days
How quickly does chronic breathlessness occur?
Over weeks/months
What does breathlessness feel like?
- Feeling unable to breath
- Cannot get your words out
- Chest feeling tight/heavy
- Can’t get enough air in
- Feel anxious
- Feel scared
What causes acute breathlessness?
- Acute asthma/COPD/bronchiectasis exacerbation
- Pleural effusion
- Pneumothorax
- Pulmonary embolism
- Foreign body in the upper airway (e.g. penny, lego block) – known as stridor
- Pneumonia
- Acute deterioration of cardiac failure
- Hyperventilation
- Neuromuscular disease (e.g. Guillan-Barré syndrome)
- Sudden onset cardiac arrhythmia
- Cardiac tamponade
What causes chronic breathlessness?
- Chronic respiratory disease (e.g. cystic fibrosis, COPD)
- Anxiety
- Congenital heart disease
- Cardiac arrhythmia
- Ischaemic heart disease
- Anaemia
- Chest wall deformity
- Obesity
- Diaphragmatic splinting (e.g. in pregnancy, ascites)
- Hypoventilation (e.g. motor neurone disease)
How can we help patients who are breathless?
- Altered positioning (in bed, sitting, standing)
- Encourage breathing from diaphragm
- Rectangular breathing
- 54321 technique
- Pacing
- Handheld fan
- Pursed lip breathing
- Being calm around patient (i.e.: no rushing, speaking loudly or quickly, etc.)
Describe the length-tension relationship of the diaphragm.
- In some respiratory conditions (e.g. COPD), the diaphragm is flattened because the lungs are hyperinflated.
- This affects the length/tension relationship so the diaphragm cannot work as effectively
What positioning can positively impact length-tension relationship of the diaphragm & why?
Forward-lean sitting
- to dome the diaphragm
How do you encourage someone to breathe from their diaphragm?
- Lie on your back + place your hands just below your ribs
- Relax the shoulders, neck, upper chest + tummy muscles
- Aim to breathe through your nose
- Notice how the tummy gently rises as you breathe in + gently falls as you breathe out again
What is the aim of rectangular breathing?
To increase time spent exhaling
How does rectangular breathing work?
- Trace a rectangle as you breathe in and out (e.g. a window)
- Try to gradually slow the speed of your breathing
- Inspiration is “active” (i.e. we contract muscles) but exhalation is “passive” (i.e. it happens as we relax are respiratory muscles). So exhalation will take longer
What happens to you respiratory rate when you feel breathless & what can this lead to?
- When breathless you tend to speed up your breathing in a panic to get more air in
- This can lead to gas trapping as the exhalation breath is not long enough to allow air out
Describe the 5-4-3-2-1 technique.
- Notice 5 things you can see
- Notice 4 things you can feel/touch
- Notice 3 things you can hear
- Notice 2 things you can smell
- Notice 1 thing you can taste
What is the aim of pacing?
Aim to avoid “boom” and “bust”
(i.e. doing as much as you can when you feel good and then running out of energy/breath and crashing)
Describe pacing.
- Break bigger tasks into smaller tasks & take regular breaks
- Remember that some days are better than others and that’s ok
- Don’t get other people to do everything for them – this will lead to deconditioning + increase breathlessness
What is a handheld fan thought to do for breathlessness?
- Stimulate the trigeminal nerve which is responsible for facial sensations.
- Sends message to the brain and reduces the perception of breathlessness.
What does pursed lip breathing do for breathlessness?
Creates some back pressure (PEEP) which splints open airways + allows greater airflow on exhalation, reducing gas trapping + hyperinflation
What is the aim of pursed lip breathing?
To prevent airway closure on expiration + increase expiratory time
