Shortness of BreathAbdulrahman Al Frayh

Professor of PediatricsConsultant Pediatric Pulmonologist

King Saud University

DefinitionShortness of breath (SOB), or dyspnea, is a feeling of difficult or labored breathing that is out of proportion to the patient’s level of physical activity.

Description

Unpleasant shortness of breath, a feeling of increased effort or tiredness in moving the chest muscles, a panicky feeling of being smothered, or a sense of tightness or cramping in the chest wall.

Acute SOBPULMONARY DISORDERS: Pulmonary disorders that can cause dyspnea include airway obstruction by a foreign object, swelling due to infection, or allergic diseases e.g. anaphylactic shock; acute pneumonia; hemorrhage from the lungs; or severe bronchospasms associated with asthma, or congenital anomalies of airways, lung and diaphragm.

Cardiovascular Disease

Acute dyspnea can be caused by disturbances of the heart rhythm, failure of the left ventricle, mitral valve dysfunction, congenital heart disease or an embolus.

TraumaChest injuries, both closed injuries and penetrating wounds, can cause pneumothorax, bruises, or fractured ribs. Pain from these injuries results in SOB.

Other CausesAnxiety attacks sometimes cause acute dyspnea; they may or may not be associated with chest pain. Anxiety attacks are often accompanied by hyperventilation. Hyperventilation raises the oxygen level in the blood, causingchest pain.

Chronic SOBPULMONARY DISORDERS. Chronic dyspnea can be caused by asthma, chronic obstructive pulmonary disease (COPD, BPD), bronchilitis, emphysema, inflammation of the lungs, pulmonary hypertension (congenital or acquired), tumors, or disorders of the vocal cords.

HEART DISEASE. Congenital, acquired heart diseases or inadequate supply of blood to the heart muscle can cause dyspnea. In some cases a tumor in the heart or pericarditis may cause dyspnea, congenital storage diseases in heart muscles may result in heart failure and SOB.

Neuromuscular Disorders

Neuromuscular disorders cause dyspnea from progressive deterioration of the patient's chest muscles. They includemuscular dystrophy, myasthenia gravis, and Werding Hoffman Disease.

Other CausesPatients who are severely anemic may develop dyspnea if they exercise vigorously. Hyperthyroidism or hypothyroidism may cause shortness of breath, and so may gastro-esophageal reflux disease (GERD).

Diagnosis

Patient History

Physical Examination

Diagnostic Tests

CBC and arterial blood gas tests to rule out infection, anemia, hyperventilation from an anxiety attack, or thyroid dysfunction. A sputum culture or nasopharyngeal aspirate can be used to test for respiratory tract infection including pneumonia.

Diagnostic TestsBASIC DIAGNOSTIC TESTS: Chest X-ray and electrocardiogram (ECG) to assist the clinician in evaluating abnormalities of larynx chest wall, also to determine the position of the diaphragm, possible rib fractures or pneumothorax, irregular heartbeat, or the adequacy of the supply of blood to the heart muscle, SPIROMETRY to screen for airway disorders.

Diagnostic Tests (cont’d)

SPECIALIZED TESTS: Specialized tests may be ordered for patients with normal results from basic diagnostic tests for dyspnea. High-resolution CT scans and/or MRI can be used for suspected airway obstruction or mild emphysema. Tissue biopsy performed with a bronchoscope can be used for patients with suspected lung disease.

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