KCP: Breathlessness

Question 1

Mechanisms that cause breathlessness

Answer 1

• Stimulation of intrapulmonary afferent nerves by interstitial inflammation or thromboembolism
• Mechanical loading of respiratory muscles by airflow obstruction or reduced lung compliance in fibrosis
• Hypoxia due to ventilation/perfusion mismatch, stimulating chemoreceptors.

Question 2

Intrapulmonary Afferent Nerves

Answer 2

The primary nerves of communications between the lungs and the central nervous system

Question 3

Interstitial Inflammation

Answer 3

Inflammation of the stuff between cells

Question 4

Thromboembolism

Answer 4

Clot

Question 5

Pulmonary Fibrosis

Answer 5

Scarring of the lung tissue

Question 6

Hypoxia

Answer 6

A state in which oxygen is not available in sufficient amounts at the tissue level to maintain adequate homeostasis

Question 7

Chemoreceptors

Answer 7

Special nerve cells or receptors that sense changes in the chemical composition of the blood

Question 8

Questions to ask: How quickly did the breathlessness come on?

Answer 8

If it came on instantly think pneumothorax, pulmonary embolus or acute allergy.

If it came on over hours think asthma, acute pulmonary oedema or acute infections

Insidious onset occurs with developing effusions, interstitial diseases and tumours.

Question 9

Pneumothorax

Answer 9

Callasped lung, air outside the lung in the cavity, this puts pressure on the lung and makes it hard to breath

Question 10

Oedema

Answer 10

Build up of fluid within interstitial spaces

Question 11

Insidious onset

Answer 11

Over a long period of time

Question 12

Pulmonary Oedema

Answer 12

Build up of fluid within the lungs, fluid collects in the air sacs

Question 13

Effusion

Answer 13

Build up of fluid within a body cavity or joint

Question 14

Questions to ask: How is your breathing at rest and overnight?

Answer 14

Asthma commonly wakes patients, while most patients with chronic obstructive pulmonary disease (COPD) are comfortable at rest and when asleep but struggle with exertion.

Question 15

Questions to ask: Is your breathing normal some days?

Answer 15

Variable breathlessness is the hallmark of asthma, while consistent daily limitation is typical in COPD

Question 16

Questions to ask: When does the breathlessness come on?

Answer 16

Asthma induced by exercise frequently appears only after exercise, during early recovery

Question 17

Patiant: “I feel I can’t get enough air (or oxygen) into my chest”

This is accompanied by normal vitals

What could this be?

Answer 17

This phrase is common with patients suffering hyperventilation due to anxiety so is therefor psychological not mechanical. This is backed up by normal vitals.

Question 18

Embolus vs Thrombus

Answer 18

A thrombus is a blood clot that forms in a blood vessel. An embolus is a particulate this travels within a blood vessel until it reaches a constriction and can’t pass.

An embolus is often a thrombus which has broken off

Question 19

Questions to ask: How far on the flat can you walk until you have to stop?

Answer 19

Doesn’t tell you much about the cause but is a good standardised question to get a sense of the severity of breathlessness

Question 20

what is the link between myocardial problems and a pulmonary oedema?

Answer 20

During poor heart function it can’t clear venous return effectively leading to a build up of venous pressure. This pressure can then cause fluid to cross over into the pulmonary space.

Question 21

What can a stony dull percussion of the lungs indicate?

Answer 21

• Consilidation
• Collapse
• Effusion

Question 22

What can an inspiratory strider ausculation indicate?

Answer 22

Upper airway obstruction

Question 23

What can a wheezy ausculation indicate?

Answer 23

Asthmer and COPD

Question 24

What does a coarse crackly ausculation indicate?

Answer 24

Pneunomia & Pulmonary Odema

Question 25

What does a fine crackly ausculation indicate?

Answer 25

Pulmonary fibrosis