Dyspnea

Question 1

What is dyspnoea?

Answer 1

Difficult, labored, uncomfortable breathing; an unpleasant type of breathing, though not usually painful.

Definitions include: the consciousness of the necessity for increased respiratory effort (Meakins, 1923); subjective experience of breathing discomfort (ATS, 2012)

Question 2

List the qualities of dyspnoea.

Answer 2

• Work/effort
• Imbalance effort/response
• Tightness
• Air hunger/unsatisfied inspiration
• Intensified by hypercapnia and hypoxaemia
• Less well characterized: rapid, heavy, expiratory difficulty.

Question 3

What physiological factors can increase dyspnoea?

Answer 3

• Increased loading of chest cage, lungs, and airways
• Increased respiratory drive
• Hypoxaemia
• Hypercapnia
• Pulmonary embolism
• Pulmonary congestion
• Inadequate performance of respiratory apparatus
• Kyphoscoliosis
• Respiratory muscle weakness.

Question 4

True or False: Patients often describe dyspnoea clearly.

Answer 4

False

Patients struggle to describe the feeling of dyspnoea.

Question 5

What is the Modified MRC (mMRC) Questionnaire used for?

Answer 5

Diagnosis, management, and prevention of COPD.

Question 6

What are common pulmonary causes of dyspnoea?

Answer 6

• Increased airflow resistance (COPD, asthma, exercise-induced, vocal cord dysfunction)
• Decreased compliance (interstitial lung disease, pulmonary congestion)
• V-Q mismatching (pneumonia, pulmonary embolism).

Question 7

What are some cardiac causes of dyspnoea?

Answer 7

• Myocardial insufficiency
• Valvular lesions.

Question 8

Fill in the blank: Dyspnoea is often complicated by _______.

Answer 8

[psychological, social, and environmental interactions]

Question 9

What investigations may be necessary for a patient with dyspnoea?

Answer 9

• Skin prick tests
• ECG
• Lung function tests (spirometry, lung volumes, diffusing capacity)
• CXR
• V/Q scan
• CTPA.

Question 10

What is the significance of hypercapnia in dyspnoea?

Answer 10

It can intensify the sensation of dyspnoea.

Question 11

What are the features of Case 1, a 25-year-old teacher with dyspnoea?

Answer 11

• 1-year history of cough and shortness of breath at night
• Occurs 3-4 times per week
• Non-smoker
• Mild asthma as a child.
• Enlarged turbinates with 75% obstruction bilaterally.

Question 12

What is the likely diagnosis for Case 3, a 60-year-old with a history of progressive shortness of breath?

Answer 12

[COPD or interstitial lung disease]

35 pack-year smoking history and cough producing greyish sputum.

Question 13

What are some miscellaneous causes of dyspnoea?

Answer 13

• Obesity
• Anaemia
• Thyrotoxicosis
• Inactivity & deconditioning
• Psychogenic causes (hyperventilation syndrome, malingering).

Question 14

What special investigations are indicated for Case 2, a 17-year-old with progressively worsening shortness of breath?

Answer 14

• ECG
• V/Q scan
• CTPA
• Spirometry for lung function.

Question 15

What does the ATS define dyspnoea as?

Answer 15

Subjective experience of breathing discomfort that consists of qualitatively distinct sensations varying in intensity.