sensory aspects of respiratory disease Flashcards
dyspnoea: explain the pathophysiology of dyspnoea, recall the main important causes of dyspnoea, explain how dyspnoea is assessed clinically and recall management principles
define dyspnoea
troublesome SOB reported by patient at inappropriately low levels of exertion; limits exercise tolerance; at rest: difficulty with inspiration or expiration; on exercise: excessive breathing for task +/- difficulty
clinical dyspnoea scale
grade 0-4 (v. severe); effect on exertion
modified Borg scale
grade 0-10 (maximal); intensity
respiratory descriptors
air hunger cluster, work/effort cluster, tightness cluster
assessing dyspnoea
volunteered comments and clinicians’ assessment, subjective rating scales (visual analogue, modifed Borg), questionnaires (exercise tolerance related, quality of life), exercise testing
disorders presenting with chronic dyspnoea
impaired pulmonary function (airflow obstuction, restriction of lung mechanics, extrathoracic pulmonary restriction, neuromuscular weakness, gas exhange abnormalities), impaired cardiovascular function (myocardial infarction, valvular, pericardial, congenital vascular disease), altered central ventilatory drive/perception (metbolic acidosis, anaemia)
general treatment goals of dyspnoea including examples
treat cause; therapeutic options (bronchodilators, drugs affecting brain, opioids, lung resection, pulmonary rehabilitation, ADH to get rid of water, meaning heart does less work), lung resection
define breathlessness
without breath or too much breathing
define tightness
difficulty in inspiring due to airway narrowing (feel chest isn’t expanding normally) - increased work and effort at high minute ventilation, high lung volume or vs. inspiratory/expiratory resistance
define air hunger cluster
sensation of powerful urge to breathe; mismatch between demand and achieved; breath feels too small
what occurs at breath holding time
break point between behavioural (voluntary) and metabolic (involuntary)
