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Cardio-Respiratory > Factors contributing to breathlessness and it's management > Flashcards

Factors contributing to breathlessness and it's management Flashcards

1
Q

Define breathlessness.

A

Awareness of increased effort which is unpleasant and recognised as inappropriate.

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2
Q

Define Orthopnoea.

A

Breathlessness upon lying down.

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3
Q

Define Paroxysmal nocturnal dyspnoea (PND)?

A

Occurs after 1-2 hours of being supine ( Increased VR puts excess load on the right side of the heart).

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4
Q

What does the term breathlessness mismatch refer to?

A

breathlessness mismatch due to a mismatch between demand for ventilation and afferent information about actual ventilation.

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5
Q

Reminder

A

see LC at 14:00 for understanding about eh load-capacity relationship = a model for understanding breathlessness.

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6
Q

What is the aetiology of breathlessness?

A
  • Increased respiratory drive
  • increased load
  • impaired capacity
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7
Q

What things can increase your reparatory drive?

A
  • Hypercapnia/acidosis
    Poor relationship between elevated CO₂ and dyspnoea but strong correlation between hypercapnia and resulting in increased VE.
  • Hypoxia
    (Caused by; anaemia, high altitude, V(=ventilation)/Q(=perfusion) mismatch)
    poor correlation between hypoxia and breathlessness but strong correlation between hypoxia resulting increase in Ve.
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8
Q

What can increase the load on the respiratory muscle pump?

A
  • Reduced compliance of the lungs
  • Obesity
  • Airflow obstruction
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9
Q

What can impair the capacity of the respiratory muscle pump?

A
  • Respiratory muscle impairment;
  • force-length relationship
  • force-velocity relationship (respiratory muscles, velocity is measured as flow)

*Peripheral muscle impairment (occurs when you avoid activity and have deconditioned, you produce more lactic acid and have to breath more for a given activity)
also hyperinflation

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10
Q

reminder

A

see LC at 21:00 for the breathing, thinking, functional clinical model.

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11
Q

During assessment of breathlessness what sensations would you measure?

A
  • Intensity
  • Unpleasantness
  • Sensory aspect
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12
Q

How could you assess the function/ impact of breathlessness?

A
  • Modified MRC scale
  • BORG scale
  • Chronic respiratory questionnaire (CRQ)
  • St George’s respiratory questionnaire.
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13
Q

What are some general aims of management of breathlessness?

A
  • Reduce ventilatory demand;
    Reduce metabolic load.
    Reduce central drive.
  • Reduce load (ventilatory independence).
  • Increase capacity.
  • Alter central perception.
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14
Q

How can you reduce metabolic load?

A
  • Exercise training = reduction in lactate for a given activity.
  • Supplement O₂
    (Very little support evidence though, mainly thought to be related to reduction in ventilation) only to be used in hypoxaemia.
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15
Q

How can you reduce their central drive for management of breathlessness?

A
  • Oxygen therapy:
    Reduced hypoxic drive from chemoreceptors proportional to reduction in ventilation. (remember the supporting evidence for this is poor)
  • Pharma logical therapy; e.g. Opiates
    (reduce Ve at rest and during exercise - alter central processing of neural signals within CNS to reduce sensations associated with breathing).
    (supporting evidence also poor with variable results).
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16
Q

How can you alter their central perception for management of breathlessness?

A
  • Education: help them understand what causes their breathlessness.
  • Cognitive behaviour (desensitisation)
  • Drug therapy
  • Vibrations
  • Fans (seems particularly effect for cancer)
17
Q

How can you increase their capacity of the reparatory muscle pump to aid management of breathlessness?

A
  • Reduce lung hyperinflation.
    (By Lung volume reduction surgery LVRS)
    or Breathing retraining (slower deeper breathing patterns will reduce physiological dead space and improve removal of CO₂, but has limited supporting evidence)
- Improve inspiratory muscle function.
by;
- Optimising nutrition
Positioning
- Inspiratory muscle training (not always appropriate e.g. degenerative neuromuscular disorder or chronic lung disease)
  • Partial ventilatory support (effective)
  • Minimise steroids. (small amount of supporting evidence)
18
Q

In the management of breathlessness what’s the role of a Physiotherapist?

A
  • Education and reassurance
  • Positioning
  • Pursed lip breathing
  • Breathing control
  • Exercise training
19
Q

How can a physiotherapist best educate and reassure patients struggling with breathlessness?

A
  • Remember that breathlessness is normal when you exercise.
  • Adopt a position that helps. (forward lean sitting)
  • Breath as quickly as you feel you need to.
  • Relax shoulders.
  • Encourage patients to wear comfortable and suitable clothing e.g. trainers, no tight pants e.g. suit pants ETC.
20
Q

Why is the forward lean sitting position good for breathlesness?

A
  • Increases force generation of the diaphragm
  • Reduce accessory mm activity
  • Reduce breathlessness.
21
Q

How does pursed lip breathing ease breathlessness?

(its of limited use not
necessarily going to help)

A
  • Increases intra-thoracic pressure
  • Patients adopt this technique spontaneously
  • Some evidence to suggest it’s of benefit to COPD patients during exertion.
22
Q

What breathing control techniques would you teach a patient to aid breathlessness?

A
  • Gentle breathing: normal tidal breathing
  • Relax shoulders and upper chest
  • Arms supported and hands relaxed (forward leaning is useful for this)
  • Never impose a breathing rate on a patient
  • Useful as part of an active cycle of breathing techniques (ACBT), during exercise and acute exacerbations.
  • Paced breathing e.g.
    when using stairs, breath in for one step, out for 1 or 2 steps DEPENDS ON THE PERSON!!!!

= “Blow as you go”

23
Q

What techniques would you use as part of an exercise training programme for breathlessness?

A
  • Use breathing control
  • Paced breathing
  • Blow as you go
  • Walking aids
  • Energy conservation.
24
Q

How do walking aids help with the management of breathlessness?

A
  • Forward leaning and fixing shoulder girdle with a rollator frame.
  • Increases ventilatory capacity:
    Reduced dyspnoea.
    Reduced fatigue.

Cardio-Respiratory (10 decks)

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