Introduction- shortness of breath is the uncomfortable sensation of not getting enough air to breathe. This may occur while walking, climbing stairs, running or even when sitting still. It is also termed as dyspnoea. Sometimes it can be harmless as the result of exercise or nasal congestion. In other situation, it may be a sign of a more serious heart or lung diseases.
CAUSES -
1) Anaphylaxis ( allergic reaction)
2) Asthma
3) Carbonmonooxide poisoning
4) COPD
5)Coronavirus disease 2019
6) Heart attack
7)Heart arrhythmia
8) Pneumonia
9) Pneumothorax
10) Pulmonary embolism
Diagnosis
1) Blood tests- Arterial blood gases and blood oxygen saturation may be measured.
2) Exercises test- blood pressure, heart rate and changes in breathing rate can be measured during exercises and rest
3) Electrocardiogram- An ECG records the electrical activity of the heart and shows abnormal rhthym.
4) Echocardiogram- An echo uses ultrasound waves to produce a moving pictures of the heart and heart valves
5) Chest x rays- An x ray will help assess lung conditions
6)Ct scan of the chest.
Severity of dyspnea
Modified Medical Research council dyspnoea scale.
Grade 0- strenous exercises
Grade 1- hurrying up or walking up a hill
Grade 2- walks slower than people of same age or stops for taking breath
Grade 3- stops for breath after walking 100m
Grade 4- breathless while dressing and underdressing breathless to leave the home.
Types of dyspnea
Orthopnea- it is the feeling of dyspnea in the recumbent position, releived by sitting or standing. Paroxysmal nocturnal dyspnea- its a sensation of dyspnea that awakens the patient, often after 1 or 2 hours of sleep, and is usually relieved in the upright position. Trepopnea - it is a sensation of dyspnoea that occurs in one lateral decubitus position as opposed to the other. Platypnea- it is a sensation of dyspnoea that occurs in the upright position and is releived with recumbency.
Management
Treatment will depend upon the cause of the problem.
In severe cases , supplemental oxygen will be needed . Those with asthma or copd may have an inhaled rescue bronchodilator to use when necessary.
If dyspnoea is linked to asthma, it typically responds well to medications such as bacterial pneumoniae , antibiotics can bring relief.
Other medication such as opiates, NSAIDS and anti- anxiety drugs can also be effectiv
Physiotherapy management
Physiotherapist can offer a variety of treatments to both adults and children who suffer from shortness of breath, giving them back the independence and control of their symptoms. Some of the treatments and techniques used are:
1) Breathing techniques
2) Manual techniques
3) Postural drainage
4) lifestyle advice
5) flutter valve
6) incentive spirometery
7) ACBT
Breathing exercises
1) pursed lip breathing helps empty the lungs of dead spaces air that occurs in COPD. To perform pursed lip breathing:
1) relax your neck and shoulder muscles.
2) slowly breathe in through your nose for two counts, keeping your mouth closed.
3) purse your lips as if you are about to whistle.
4) breathe out slowly and gently through your pursed lips to the count of four.
Sitting forward supported by a table.
1) Sit in a chair with your feet flat on the floor, facing a table.
2) lean your chest slightly forward and rest your arms on the table .
3) Rest your head on your forearms or on a pillow.
Diaphragmatic breathing
1) Sit in a chair with bent knees and relaxed shoulders, head and neck.
2) place your hand on your belly.
3) Breathe in slowly through your nose . You should feel your belly moving under your hand.
4) As you exhale, tighten your muscles . You should feel your belly fall inward. Breathe out through your mouth with pursed lips.
5) Put more emphasis on the exhale than the inhale. Keep exhaling for longer than usual before slowly inhaling again.
6) Repeat for about mins