APPROACH TO ACUTE

BREATHLESSNESS
Sincerely by,
Mohd Ikhwan bin Ahmad
Mohamad Mursyid Mukmin bin Mohd
Yasir
 OUTLINES
• Asthma
• Chronic Obstructive Airway Disease
• Pulmonary embolism
• Pulmonary oedema
 DEFINITION
• Dyspnea/ Shortness of breath
is a feeling of difficulty in breathing
• A non-specific symptom
• May be caused by cardiac, respiratory,
neuromuscular, metabolic or psychogenic
problems.
• Either acute or chronic.
CAUSES OF BREATHLESSNESS
ASTHMA
in
adults
 DEFINITION
• Acute exacerbation of asthma is progressive or
sudden onset of worsening symptoms such as
shortness of breath, chest tightness, wheezing
and coughing.
• Status asthmaticus?
PATHOPHYSIOLOGY
 Asthma

Acute
Chronic
(exacerbation)
Main history
• Time of onset
• Severity of symptoms
• Current treatment
• Risk factors of asthma related-deaths
• To look for cause of exacerbation
Severity assesment in acute exacerbation
Risk of asthma related deaths
 DIAGNOSIS OF ASTHMA

Positive
Typical obstructive
clinical airflow
reversibility
history
WITH
spirometry

*(spirometry better than PEFR)

Recommendations
CHRONIC OBSTRUCTIVE
PULMONARY DISEASE
(COPD)
 DEFINITION
• A preventable and treatable respiratory disorder,
largely caused by smoking, is characterised by
progressive, partially reversible airflow obstruction
and lung hyperinflation with significant extra-
pulmonary systemic manifestation and co-morbid
condition of which may contribute to the severity of
the disease
PATHOPHYSIOLOGY
Insult.
Eg: smoking / other
irritant
 DIAGNOSIS OF COPD
Symptoms of
History of
chronic cough,
exposure to risk
sputum
factors, especially
production or
cigarette smoking
dyspnea

Confirmed by spirometry showing a post-

bronchodilator FEV1 / FVC ratio of less than
70% that is not fully reversible
 Assessment and monitoring
1) Initial diagnosis – confirmed by spirometry
2) Assessment of symptoms
– dyspnea is the hallmark
- cough is often 1st symptom
- extrapulmonary manifestations
- co-morbidities
3) Medical history
4) *Physical examination
- not usually diagnostic
- Signs of
- airflow limitation (reduce breath sound, prolonged
expiratory phase) and
- air trapping (reduce cardiac and liver dullness, barrel
chest)
- usually when disease at advanced stage
- May detect comorbidities and complications
5) Measurement of lung function
6) Bronchodilator reversibility test
- 200ml AND
- 12%
7) Assessment of COPD severity
• BODE index
– BMI
– Obstruction (FEV1)
– Dyspnoea (MMRC)
– Exercise tolerance (6minute walk test)
• Patient’s individual symptoms
• Presence of extra pulmonary systemic manifestations
• Co-morbidities
• Presence of complications
- Respiratory failure
- Cor pulmonale
- Weight loss
Classification of COPD severity based on
Spirometric Impairment and Symptoms
Assessment of severity
MMRC Dyspnea Scale
 Objectives of Managing Acute
Exacerbation of COPD

Relieve symptoms and airflow obstructions

Maintain adequate oxygenation
Treat any co-morbid conditions that may
contribute to the respiratory deterioration
Treat any precipitating factor such as infection
Algorithm for managing acute exacerbation
of COPD : Hospital management
Algorithm for managing acute exacerbation of COPD :
Home management

• Pg 7 cpg
To be continue…