Shortness of breath, or dyspnea, is a feeling of difficult or labored breathing

that is out of proportion to the patient's level of physical activity. Itis a

symptom of a variety of different diseases or disorders and may be either acute
or chronic.
The experience of dyspnea depends on its severity and underlying causes.
Thefeeling itself results from a combination of impulses relayed to the brain
from nerve endings in the lungs, rib cage, chest muscles, or diaphragm,
combined with the patient's perception and interpretation of the sensation. In
somecases, the patient's sensation of breathlessness is intensified by anxiety
about its cause. Patients describe dyspnea variously as unpleasant shortness
ofbreath, a feeling of increased effort or tiredness in moving the chest muscles,
a panicky feeling of being smothered, or a sense of tightness or crampingin the
chest wall.
Acute dyspnea with sudden onset is a frequent cause of emergency room
visits.Most cases of acute dyspnea involve pulmonary (lung and breathing)
disorders, cardiovascular disease, or chest trauma.
Pulmonary disorders that can cause dyspnea include airway obstruction by a
foreign object, swelling due to infection, or anaphylactic shock; acute
pneumonia; hemorrhage from the lungs; or severe bronchospasms associated
with asthma.
Acute dyspnea can be caused by disturbances of the heart rhythm, failure of
the left ventricle, mitral valve (a heart valve) dysfunction, or an embolus
(aclump of tissue, fat, or gas) that is blocking the pulmonary circulation. Most
pulmonary emboli (blood clots) originate in the deep veins of the lower legs
and eventually migrate to the pulmonary artery.

Chest injuries, both closed injuries and penetrating wounds, can cause
pneumothorax (the presence of air inside the chest cavity), bruises, or
fractured ribs. Pain from these injuries results in dyspnea. The impact of the
driver'schest against the steering wheel in auto accidents is a frequent cause of
closed chest injuries.
Anxiety attacks sometimes cause acute dyspnea; they may or may not be
associated with chest pain. Anxiety attacks are often accompanied by
hyperventilation, which is a breathing pattern characterized by abnormally
rapid and deep breaths. Hyperventilation raises the oxygen level in the blood,
causing chest pain and dizziness.
Chronic dyspnea can be caused by asthma, chronic obstructive pulmonary
disease (COPD), bronchitis, emphysema, inflammation of the lungs,
pulmonary hypertension, tumors, or disorders of the vocal cords.
Disorders of the left side of the heart or inadequate supply of blood to theheart
muscle can cause dyspnea. In some cases a tumor in the heart or inflammation
of the membrane surrounding the heart may cause dyspnea.
Neuromuscular disorders cause dyspnea from progressive deterioration of the
patient's chest muscles. They include muscular dystrophy, myasthenia gravis,
and amyotrophic lateral sclerosis.
Patients who are severely anemic may develop dyspnea if they exercise
vigorously.classify Hyperthyroidism or hypothyroidism may cause shortness
of breath,and so may gastroesophageal reflux disease (GERD). Both chronic
anxiety disorders, and a low level of physical fitness can also cause episodes of
dyspnea. Deformities of the chest or obesity can cause dyspnea by limiting the
movement of the chest wall and the ability of the lungs to fill completely.

The patient's history provides the doctor with such necessary information asa
history of gastroesophageal reflux disease (GERD), asthma, or other allergic
conditions; the presence of chest pain as well as difficulty breathing; recent
accidents or recent surgery; information about smoking habits; the patient's
baseline level of physical activity and exercise habits; and a psychiatric history
of panic attacks or anxiety disorders.
How a person's body position affects his/her dyspnea symptoms sometimes
giveshints as to the underlying cause of the disorder. Dyspnea that is worse
whenthe patient is sitting up is called platypnea and indicates the possibilityof
liver disease. Dyspnea that is worse when the patient is lying down is called
orthopnea, and is associated with heart disease or paralysis of the diaphragm.
Paroxysmal nocturnal dyspnea (PND) refers to dyspnea that occurs
duringsleep and forces the patient to awake gasping for breath. It is usually
relieved if the patient sits up or stands. PND may point to dysfunction of the
left ventricle of the heart, hypertension, or narrowing of the mitral valve.
The doctor will examine the patient's chest in order to determine the rate and
depth of breathing, the effort required, the condition of the patient's breathing
muscles, and any evidence of chest deformities or trauma. He or she will listen
for wheezing, stridor, or signs of fluid in the lungs. If the patient has a fever,
the doctor will look for other signs of pneumonia. The doctorwill check the
patient's heart functions, including blood pressure, pulse rate, and the
presence of heart murmurs or other abnormal heart sounds. If thedoctor
suspects a blood clot in one of the large veins leading to the heart,he or she
will examine the patient's legs for signs of swelling.
Patients who are seen in emergency rooms are given a chest x ray and an
electrocardiography (ECG) to assist the doctor in evaluating abnormalities of
thechest wall, also to determine the position of the diaphragm, possible rib

fractures or pneumothorax, irregular heartbeat, or the adequacy of the supply

ofblood to the heart muscle. Also, the patient may be given a breathing test on
an instrument called a spirometer to screen for airway disorders.
The doctor may order blood tests and arterial blood gas tests to rule out
anemia, hyperventilation from an anxiety attack, or thyroid dysfunction. A
sputum culture can be used to test for pneumonia.
Specialized tests may be ordered for patients with normal results from
basicdiagnostic tests for dyspnea. High-resolution CT scans 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.
If the doctor suspects a pulmonary embolism, he or she may order ventilationperfusion scanning to inspect lung function, an angiogram of blood vessels, or
ultrasound studies of the leg veins. Echocardiography can be used to test for
pulmonary hypertension and heart disease.
Pulmonary function studies or electromyography (EMG) are used to assess
neuromuscular diseases. Exercise testing is used to assess dyspnea related to
COPD, anxiety attacks, poor physical fitness, and the severity of lung or heart
disease. The level of acidity in the patient's esophagus may be monitored to
rule out GERD.
Treatment of dyspnea depends on its underlying cause. Patients with acute
dyspnea are given oxygen in the emergency room, with the following
treatments for specific conditions:
Asthma. Treatment with Alupent, epinephrine, oraminophylline.
Anaphylactic shock. Treatment with Benadryl, steroids, or
aminophylline, with hydrocortisone if necessary.

 heart failure.Treatment with oxygen, diuretics, and placing patient in

upright position.
Pneumonia. Treatment with antibiotics and removal of lung secretions.
Anxiety attacks. Immediate treatment includes antidepressant
medications. If the patient is hyperventilating, he or she may be asked to
breathe into a paper bag to normalize breathing rhythm and the oxygen
level of the blood.
Pneumothorax. Surgical placement of a chest tube.
The treatment of chronic dyspnea depends on the underlying disorder.
Asthma can often be managed with a combination of medications to reduce
airway spasmsand removal of allergens from the patient's environment. COPD
requires bothmedication, lifestyle changes, and long-term physical
rehabilitation. Anxietydisorders are usually treated with a combination of
medication and psychotherapy. GERD can usually be managed with antacids,
other medications, and dietary changes. There are no permanent cures for
myasthenia gravis or muscular dystrophy.
Tumors and certain types of chest deformities can be treated surgically.
The appropriate alternative therapy for shortness of breath depends on the
underlying cause of the condition. When dyspnea is acute and severe, oxygen
therapy is used either in the doctor's office or in the emergency room. For
shortness of breath with an underlying physical cause like asthma,
anaphylactic shock, or pneumonia, the physical condition should be treated.
Botanical and homeopathic remedies can be used for acute dyspnea, if the
proper remedies andformulas are prescribed. If the dyspnea has a

psychological basis (especially if it is caused by anxiety), acupuncture,

botanical medicine, and homeopathy can help the patient heal at a deep level.
The prognosis (expected outcome) depends on the underlying cause of the
dyspnea, its severity, and the type of treatment required.
Dyspnea caused by asthma can be minimized or prevented by removing dust
and other triggers from the patient's environment. Long-term prevention of
chronicdyspnea includes such lifestyle choices as regular aerobic exercise and
avoidance of smoking.

Referance:
Video 2. How Do Your Lungs Work?
https://www.youtube.com/watch?v=Cy1lfZAIojs