Dyspnea

Prof Hafeezul Hassan

 Learning Objectives
 After the end of this lecture the student
should know about the;

• Definition and types of dyspnea

• Pathophysiology and causes of dyspnea

• Classifications of dyspnea
 Dyspnea
Breathlessness is an uncomfortable sensation or
awareness of breathing

DEFINITION: Dyspnea is defined as difficult or labored

breathing or the unpleasant awareness of ones breathing

 The American Thoracic Society defines dyspnea as a

“subjective experience of breathing discomfort that
consists of qualitatively distinct sensations that vary in
intensity

Dyspnea may be the chief physical complain of patients

with underlying cardio respiratory and hematological
disorders
 Dyspnea Types

 Exertional dyspnea

 Resting dyspnea

 Orthopnea

 Parzoxysmal Nocturnal dyspnea (PND)

Pathophysiology of dyspnea
 Dyspnea cont…
• Factors which causes sensation of Dyspnea:
• 1) Abnormality of respiratory gases in body
fluids, especially hypercapnea and to a much
less extent hypoxia
• 2) The amount of work that must be perform
by respiratory muscles to provide adequate
ventilation
• 3) State of mind
 Reversible Causes
• Infection
• Pleural effusion
• Pneumothorax
• PE
• Airway obstruction
• Anaemia
• CCF
 Dyspnea Classification
• Medical research council classification:

• Grade 1: Troubled by shortness of breath when

hurrying on level ground or walking up a slight hill

• Grade 2: Short of breath when walking with a

people of own age on level ground

• Grade 3: Have to stop for breath when walking at

own pace on level ground
 Dyspnea Classification cont….
• Grading of severity of shortness of breath
adopted from Sherwood johns:

• Grade 1A: Able to carryout house work or job

with moderate difficulty. Sleep occasionally
disturbed.

• Grade 1B: Only able to carry out house work

or job with great difficulty .sleep frequently
disturbed.
 Dyspnea Classification cont….
• Grade 2A: Confined to chair or bed but able to
get up with moderate difficulty. Sleep disturbed.

• Grade 2B: Confined to chair or bed and only able

to get up with great difficulty .unable to sleep.

• Grade 3:Totally confined to chair or bed. No sleep

• Grade 4:Immobalized and completely exhausted.

NYHA Classification
 Non Pharmacological Management
• Positioning
• Airflow - use of fan /window
• Relaxation / Distraction/ Reassurance
• Energy conservation / Pacing
• Controlled Breathing techniques /physio
• Loose clothing
• Mouth Care
 Pharmacological Management

• Oxygen therapy only where appropriate (mixed evidence,

check sats if hypoxic resting O2 below 90% 2l/min)
• Steroids
• Bronchodilators nebulised (Salbutomol 2.5 -5mg prn*)
• Antibiotics
• Nebulised saline to thin secretions or Carbocisteine if
secretions difficult to expectorate and exacerbating breathing
difficulties
• Blood transfusion