Expiratory dyspnea is a disorder of the lungs that makes it difficult to exhale. The disease is a consequence of loss of elasticity of the inner walls of the lungs, narrowing of the mucous passages of the bronchioles, convulsive contraction of the lung muscles, or an allergic reaction.

Signs

Expiratory dyspnea manifests itself in an increase in the duration of exhalation, while causing the patient to struggle to breathe.

Signs of expiratory shortness of breath may include:

• pain in the chest during exhalation;
• hyperhidrosis;
• increased cervical venous pressure;
• blue lips;
• paleness of the patient's skin and face.

Pathological shortness of breath is also accompanied by the following features:

• general weakness and increased shortness of breath;
• the skin takes on a bluish color.

The consequence of the accumulation of excess air during the long-term development of expiratory dyspnea is characteristic of the disease. percussion sound. Percussion is accompanied by a shift in the boundaries of the lungs. There may also be difficulties in contracting the diaphragm.

In addition, expiratory dyspnea may occur ripping And whistling sounds during the patient's exhalation.

Causes

Depending on the types of pathology, expiratory shortness of breath occurs for the following reasons:

• At dysfunction of the respiratory department in the trunks of the medulla oblongata. May occur as a result of exceeding the dose of sleeping pills, narcotic, anesthetic medications. The disorder is accompanied by changes in the depth and frequency of breathing.
• At thoraco-phrenic disorders of the thoracic aorta. Expiratory shortness of breath can occur as a result of deformation of the vertebral part of the body due to excessive accumulation of fluid in the chest cavity. As the disease develops, the patient experiences a cough, accompanied by the active elimination of viscous sputum.
• At bronchial obstruction. Shortness of breath can occur as a result of dysfunction of the bronchi, due to a violation of the elasticity of intrapulmonary tissues. Expiratory shortness of breath occurs with bronchial asthma, bronchopulmonary cancer, inflammation of the bronchi, or when a foreign body enters the bronchial aorta. Symptomatically, shortness of breath with bronchial obstruction can manifest itself in the form of sudden attacks of suffocation. A calm and even inhalation may be followed by a noisy exhalation, requiring significant effort from the patient.
• At disorders of the cardiovascular system. Expiratory shortness of breath in this case, as a rule, manifests itself as a result of dysfunction of the left ventricular part of the brain and slow blood circulation in the small stomach. Expiratory shortness of breath can result from the following disorders of the cardiovascular system: hypertension, myocardial dysfunction, coronary heart disease and other heart diseases. At the initial stage of development, patients experience shortness of breath, manifested in a lack of air. With the development of pathology, expiratory shortness of breath occurs in the form of attacks of suffocation even with little physical activity. The last degree of expiratory dyspnea in case of a violation of the cardiovascular system is accompanied by suffocation in the patient even at rest and sleep. Symptoms of the final stage of the disease indicate that shortness of breath becomes a chronic pathology.
• At change in pH concentration in blood. Expiratory shortness of breath due to a violation of the blood composition can occur due to liver and kidney disorders, as well as disorders of the endocrine system. Patients experience increased frequency and depth of breathing, decreased appetite, apathy, and pale skin. As the pathology develops, the patient's pale skin becomes yellow.

Expiratory shortness of breath may also be caused by chemical factors:

• fluctuations in the acid-base balance of the blood;
• lack of oxygen content;
• excess concentration of carbon dioxide in the blood.

Also, the development of expiratory shortness of breath may be due to the following factors:

• metabolic disorder (see also:);
• obesity (as a result of heart overload, blood is pumped in excess);
• deterioration of diaphragm mobility;
• (due to a decrease in the number of red blood cells in the body, the oxygen balance in the blood is disturbed);
• mental disorder (hysteria);
• pregnancy.

Expiratory dyspnea in bronchial asthma

The cause of expiratory shortness of breath in bronchial asthma is dysfunction of the bronchial aorta. During illness, swelling of the mucous membrane of the respiratory tract occurs and spasm of the smooth muscles of the bronchi occurs. Therefore, expiratory shortness of breath in bronchial asthma is accompanied by difficulty in exhalation due to pathological narrowing of the walls of the bronchial cavity. The spasm intensifies in the morning and at night.

Expiratory shortness of breath in bronchial asthma is accompanied by sudden attacks of suffocation. Having calmly taken a short breath, the patient experiences serious difficulties and noisy sounds when exhaling.

Treatment of expiratory shortness of breath in bronchial asthma is effectively relieved by inhalation beta-agonists(for example, Fenoterol, Berotec, Salbutamol). Since these medications have a short-term effect, patients are not recommended to take more than two uses at a time. At least 20 minutes should pass between inhalation sessions.

With expiratory dyspnea, unlike patients with heart disease, patients do not need to be placed with their torso up to improve breathing. If an attack occurs, the patient should take a sitting or half-sitting position, keeping his hands resting on the seat of the bed.

Diagnosis and treatment methods

Diagnosis and treatment of expiratory shortness of breath should be aimed at eliminating the disorders that cause expiratory shortness of breath. That is, in order to eliminate or reduce expiratory shortness of breath, it is necessary to first eliminate the underlying disease. Depending on the type of underlying disease, treatment for shortness of breath may vary:

• Bronchodilator medications are recommended to eliminate spasms in bronchial asthma. Recommended for treatment inhalation of beta-agonists short-term effects - Fenoterol, Berotek, Salbutamol.
• Cardiac glycosides for the treatment of expiratory dyspnea will help with dysfunction of the left ventricular part of the heart. For cardiac dyspnea of ​​expiratory type, treatment is necessary beta blockers, such as Acebutolol, Metoprolol, Propranolol. Treatment is also possible antiarrhythmic medications, for example, Diltiazem, Verapamil, Amiodarone.
• Puncture is provided for excessive accumulation of fluid in the pleural cavity of the bronchi. In addition to pleural puncture to treat shortness of breath, the doctor may prescribe UHF therapy, and massage And breathing exercises.

To identify the nature and causes of expiratory shortness of breath, it is necessary to undergo the following studies:

• electrocardiogram;
• echocardiography;
• X-ray;
• studies of gas balance in arterial blood.

With help pneumotachometry And vital capacity measurements(vital capacity of the lungs) the degree of development of bronchial obstruction is revealed.

If expiratory shortness of breath is accompanied by a severe form of oxygen deficiency at night, then it is necessary to undergo treatment with deep ultrasonic sanitation in combination with immunotherapy sessions.

To eliminate expiratory shortness of breath, even when using most modern bronchial therapy, additional conditions must be observed:

• stop smoking, which in turn will reduce the level of carbon monoxide and nicotine in the blood;
• follow a physical rehabilitation regimen that will help maintain stability during physical activity.

First aid

In case of expiratory shortness of breath, to provide first aid to the patient, it is necessary to take a sitting or semi-sitting position in a chair. Eliminating stress factors in a patient is also one of the main measures to provide medical care, since a tense state causes the patient to accelerate the heart rate, as a result of which heart failure worsens.

In the room in which the patient is located, the air should be humid. You can boil water with the lid open, hang wet towels, or fill the bathtub with hot water. In addition, the room should be well ventilated. If necessary, you can open a window or door.

Preventive actions

To reduce or prevent the occurrence of expiratory shortness of breath, it is necessary, first of all, to quit smoking. Smoking has a direct effect on the development of shortness of breath, even in healthy people. Smokers have increased levels of carboxyhemoglobin, which sharply increases the risk of expiratory shortness of breath.

In case of an allergic reaction of the bronchi, it is necessary to completely eliminate the factor of the allergen impact on the patient with expiratory shortness of breath.

The premises must be regularly wet cleaned.

Patients with expiratory dyspnea can use expectorant medications and mucolytic drugs if the shortness of breath is a consequence of obstruction of the bronchial cavity.

Excessive hypothermia causes the risk of expiratory shortness of breath, so sudden changes in temperature must be avoided.

The most important factor for preventing expiratory shortness of breath and any other disease is improving lifestyle, giving up bad habits, maintaining proper nutrition and eight hours of sleep.

Features of expiratory dyspnea in children

The structure of the body of children and adults is completely different, so the identification of expiratory shortness of breath in children is different. It is possible to detect expiratory shortness of breath in a child if the number of breaths per minute exceeds the following norms:

• about 60 breaths in children from 0 to 6 months;
• 50 breaths per minute in children 6-12 months;
• in children from 1 year to 5 years, the number should not exceed 40 breaths per minute;
• for children from 5 to 10 years old, 25 breaths per minute are typical;
• 20 breaths per minute for children from 10 to 14 years old.

The following forms of shortness of breath are distinguished.

Inspiratory dyspnea. Observed with obstruction of the upper respiratory tract (croup, foreign body, cysts and tumors, congenital narrowing of the larynx, trachea, bronchi, retropharyngeal abscess, etc.). Difficulty breathing during inhalation is clinically manifested by retraction of the epigastric region, intercostal, supraclavicular spaces, jugular fossa and tension m. sternocleidomastoideus and other accessory muscles.

Expiratory dyspnea. The chest is raised upward and is almost not involved in the act of breathing. The rectus abdominis muscles, on the contrary, are tense. The exit occurs slowly, sometimes with a whistle. It is observed in bronchial asthma, with partial compression of the bronchi.

Chic's shortness of breath. Expiratory “panting” depends on compression by tuberculous infiltrates and lymph nodes of the root of the lung, the lower part of the trachea and bronchi, which freely allow air to pass through only when inhaling.

Mixed dyspnea – expiratory-inspiratory. It manifests itself as swelling of the chest and retraction of compliant areas. Mixed shortness of breath is characteristic of bronchiolitis and pneumonia.

Stenotic breathing due to obstructed passage of air through the upper respiratory tract (croup, compression by tumor).

Choking attacks - asthma. Inhalation and exhalation are loud, drawn out, and can often be heard from a distance. Characteristic of bronchial asthma.

Particularly significant respiratory disturbances are observed in newborns for respiratory distress syndrome, which is always accompanied by severe respiratory failure. Respiratory distress syndrome is more common in premature infants.

With respiratory distress syndrome, the baby's cry at birth is weak or even absent. There is marked muscle hypotonia, decreased reflexes, pallor or cyanosis. It is noteworthy that the child’s breathing with a groaning inhalation, but without stenotic respiratory noise, is superficial. When examining a child, you can already get an idea of ​​the severity of the condition based on clinical signs.

Criteria for the severity of respiratory distress syndrome.

Criteria	Severity
Comparative movements of the sternum and abdomen Retraction of intercostal spaces Sternal retraction Recession of the chin during inhalation Expiratory grunt	Synchronous	Late retraction of the sternum, minimal protrusion of the abdomen Moderate Observed, but mouth remains closed Can only be heard with a stethoscope	Breathing is paradoxical Significant Observed but mouth open Can be heard without a stethoscope

Congenital stridor is a peculiar disease of early age, characterized by inspiratory noise during breathing. The noise is whistling, ringing, reminiscent of the cooing of pigeons, sometimes the purring of a cat, or the clucking of a chicken. The intensity of the noise decreases during sleep, when moving the child from a cold room to a warm one, if the child is calm; on the contrary, it increases with excitement, screaming, coughing. The general condition of the child with stridor is slightly disturbed, breathing is slightly difficult, sucking occurs normally, the voice is preserved. Stridor usually begins immediately or shortly after birth, decreases in the second half of the year and heals on its own by 2-3 years. The basis of this disease, according to most authors, is an anomaly in the development of the outer ring of the larynx and arytenoid cartilages. The epiglottis is soft and folded into a tube. The aryepiglottic ligaments are close to each other and form, as it were, loose sails, which oscillate when inhaling, creating noise.

Stridor can be of inspiratory or expiratory type. When a child develops stridor, it is necessary to determine whether there is a significantly enlarged thymus gland, bronchoadenitis, congenital heart disease, or a mediastinal tumor that can cause compression and changes in breathing patterns. In severe forms of stridor, it is advisable to conduct a laryngoscopic examination to determine whether the stridor is caused by a polyp or congenital membrane of the vocal cords. It is also necessary to remember about retropharyngeal or retrotonsillar abscess as the cause of stridor breathing.

Expiratory shortness of breath occurs when bronchospasm occurs. In this case, the patency of the small bronchi is impaired. The bronchioles narrow, secretions accumulate in them, and the mucous membrane swells.

Types of shortness of breath

Doctors often refer to it as dyspnea. This is a function that occurs in a number of diseases. Dyspnea may be inspiratory. It is characterized by difficulty breathing. This type of dyspnea can occur with heart failure or with damage to the upper respiratory tract. It can appear due to bronchospasm, accumulation of pathological secretions, tumors compressing the airways, and swelling of the mucous membrane.

Slow exhalation, during which a slight whistle may be heard, is a sign that expiratory shortness of breath has begun. It occurs when the mucous membrane swells, secretions accumulate in the bronchioles, or obstacles appear that impair the patency of the small bronchi.

There is also mixed shortness of breath. It is characteristic of acute respiratory failure.

You need to understand that shortness of breath - inspiratory and expiratory - is caused by different reasons. Therefore, approaches to treating these conditions also differ.

Causes of expiratory shortness of breath

People suffering from bronchial asthma or frequent obstructive bronchitis know what symptoms accompany these diseases. One of their main symptoms is the appearance of shortness of breath. It is characterized by a slow exhalation, which is accompanied by a whistle. The chest is practically not involved in breathing. She is constantly in a position characteristic of inhalation.

Respiratory shortness of breath is characteristic of diseases such as:

Bronchial asthma;

Bronchiolitis or obstructive bronchitis;

Chronic pulmonary ephysema, characterized by loss of tissue elasticity;

Bronchial tumors;

Pneumosclerosis of the lungs.

It can also appear when a foreign body enters the respiratory tract. But when an obstacle appears in the trachea and larynx, inspiratory dyspnea appears. But when the large bronchus and trachea narrow, both inhalation and exhalation become difficult.

Characteristic signs

If violated, expiratory shortness of breath may occur. In this case, inhalation is performed normally, but exhalation is difficult. To release air from the lungs, the patient is forced to make efforts. The respiratory muscles begin to work more actively.

Many people complain of pain in the chest area. Cyanosis of the lips may also develop, and the skin becomes noticeably pale. People with this type of dyspnea often experience excessive sweating. As the situation worsens, the skin may acquire a gray tint, and weakness noticeably increases.

Despite the fact that with expiratory shortness of breath it is difficult to exhale, the patient may begin to experience dyspnea. However, dyspnea may not be expressed. The intensity of the manifestations of shortness of breath will depend on the reasons for which it appeared, on the stage of the disease, and the presence of sputum.

With the development of this type of dyspnea, air can enter the lungs, but due to swelling and spasm of the walls of the bronchi, it does not come out completely. Often the situation is complicated by the accumulation of viscous mucus.

Clinical signs

It is not always possible to understand that the patient has breathing problems. In order to pay attention in time and notice the onset of an attack before complications arise, you need to know the signs of expiratory shortness of breath.

One of the main things to pay attention to is the length of the outlet. It increases noticeably. In some cases, its duration may exceed the length of inspiration by 2 times. Exhalation is accompanied by significant muscle tension. Symptoms of changes in intrathoracic pressure also appear. This is evidenced by the bulging and collapse of the intercostal spaces. At the same time, as you exhale, the veins of the neck become visible.

Expiratory shortness of breath is characteristic of bronchial asthma. With a long course of this disease, you can notice a characteristic box sound, which occurs due to excess air accumulation. After all, this limits the movement of the diaphragm. When tapping certain areas of the chest, you may notice that they are drooping.

But there are other signs of expiratory shortness of breath that can be noticed by people without medical education. When exhaling, you may hear a slight whistle or a characteristic crunching sound (crepitus). In some cases, it can even be heard from a distance.

Symptoms of diseases

Taking into account the fact that expiratory shortness of breath is a sign of the development of some kind of respiratory tract disease, one must understand how the disease should be determined.

For example, if a patient has obstructive bronchitis, then its characteristic sign is not only the development of respiratory failure, but an increase in temperature. In addition, the patient has increased weakness, pale skin, and acrocyanosis. A bluish color of the skin appears on areas of the body remote from the heart: fingers and toes, ears, lips, tip of the nose.

But often such a symptom is a sign that asthma has begun. Expiratory shortness of breath occurs during exacerbation of this disease. In most cases, it begins upon contact with an allergen. The disease is seasonal. But deterioration can occur when inhaling tobacco smoke or other substances with a strong odor. Sometimes exacerbation of asthma is associated with increased physical activity. Often attacks begin in the morning or evening hours.

Diagnosis of problems

In some cases, it is necessary to conduct special examinations to understand the nature of the shortness of breath that appears. Its occurrence in childhood is especially dangerous. In children, expiratory shortness of breath is often observed with obstructive bronchitis. In this case, you need to seek help from a hospital. A medical institution can not only accurately establish a diagnosis, but also provide the necessary qualified assistance.

The nature of shortness of breath can be determined using radiography, ECG, and echocardiography. A blood gas composition study is also indicated. The degree of bronchial obstruction can be determined by measuring the vital volume of the lungs or doing pneumotachometry.

First aid

If you or someone around you suffers from asthma attacks, then you need to know what can be done before the doctors arrive. First of all, such a patient must be seated and try to calm him down. Stress leads to increased heart rate and increased consumption of oxygen and a number of nutrients. Because of this, expiratory shortness of breath may begin to develop more severely.

The room in which a patient with an attack of dyspnea is located should be well ventilated. In addition, attention should be paid to air humidity. If it is excessively dry, then it is advisable to put a saucepan or kettle with water on the fire and open the lid. You can also hang wet towels or sheets.

Necessary treatment

If the cause of shortness of breath is a spasm, then bronchodilators can help. People suffering from asthma should always have inhalers on hand. Such patients should use leukotirene receptor antagonists, cromones, during attacks. If the patient is not prescribed appropriate therapy, then over time he may become less sensitive to bronchial dilators (substances that relax smooth muscles and help increase their lumen). Because of this, the patient may experience uncontrollable attacks of shortness of breath.

To relieve spasms, drugs such as Salbutamol, Berotek, Ventolin, Metaprel, Fenoterol, Berodual, Terbutaline can be used. But each of these medications has side effects and contraindications. Therefore, the selection of the right drug must be carried out together with a doctor.

For obstructive bronchitis, inhalations are also prescribed, because this disease is characterized by the appearance of expiratory shortness of breath. The plan in this case is to provide bed rest to the patient, limit physical activity and organize the treatment process. The nurse must ensure that all doctor's orders are followed.

Preventive measures

In some cases, with respiratory diseases, the development of an attack can be prevented. To do this, you must follow the recommendations of doctors. They boil down to what is needed:

Quit smoking and other bad habits, avoid visiting places where there may be tobacco smoke;

Minimize contact with possible allergens, including household chemicals;

Carry out hardening, vitamin therapy;

Review your lifestyle, devote sufficient time to proper nutrition and rest;

If bronchitis develops, use expectorants;

If a bacterial infection occurs, use antibiotics.

Compliance with recommended preventive measures and prompt initiation of treatment in the event of an attack will help the patient to control dyspnea. It is also important to remember that expiratory shortness of breath occurs in diseases of the respiratory tract due to narrowing of the small bronchi. Symptomatic therapy should be aimed at relaxing the smooth muscles.

Shortness of breath is a feeling of lack of air, due to which there is a need to increase breathing. This is one of the most common complaints patients have when visiting a general practitioner or therapist.

It is a common sign of disease in various organs and systems of the human body - respiratory, cardiovascular, endocrine, nervous.

Shortness of breath is accompanied by:

• infectious diseases
• various types of intoxication
• neuromuscular inflammatory processes
• but it can also occur in completely healthy overweight people with detraining of the body - sedentary lifestyle, obesity
• in persons with a labile nervous system as a psycho-emotional reaction to stress
• for metabolic disorders, blood diseases, oncology

This symptom can be both pathological compensatory and physiological in nature, and its severity often does not correspond to the degree of pathological disorders in the body. Multifactoriality and low specificity in many cases make it difficult to use for diagnosis or assessment of the severity of a particular disease. However, a detailed and multi-stage examination of the patient to determine the cause of shortness of breath is mandatory.

What is shortness of breath?

Shortness of breath, or dyspnea (breathing disorder) can be accompanied by objective respiratory disturbances (depth, frequency, rhythm) or only by subjective sensations.

According to the definition of academician B.E. Votchal, shortness of breath is primarily a patient’s sensation, forcing him to limit physical activity or increase breathing.

If breathing disorders do not cause any sensations, then this term is not used, and we can only talk about assessing the nature of the disorder, that is, breathing is labored, shallow, irregular, excessively deep, intensified. However, this does not make the suffering and psychological reaction of the patient any less real.

The definition of dyspnea proposed by the US Thoracic Society is currently accepted. According to it, shortness of breath is a reflection of the patient’s subjective perception of respiratory discomfort and includes various qualitative sensations varying in intensity. Its development can cause secondary physiological and behavioral reactions and be determined by the interaction of psychological, physiological, social and environmental factors. The following degrees of shortness of breath are distinguished:

No shortness of breath	Shortness of breath on exertion occurs only during severe physical exertion (playing sports, lifting weights up stairs, jogging, long swimming), then breathing quickly recovers
Mild shortness of breath	The occurrence of shortness of breath when walking quickly, climbing stairs for a long time, or uphill
Average	Due to difficulty breathing, a person is forced to walk more slowly, sometimes stopping while walking to catch his breath
Heavy	When walking, the patient stops every few minutes, that is, he walks no more than 100 meters and stops in order to restore breathing
Very heavy	Shortness of breath occurs even at rest or with the slightest movement or physical activity, the patient usually does not leave the house

The following example demonstrates a more complete understanding of shortness of breath.

• The normal number of breaths in a healthy person at rest is 14–20 per minute.
• In a person who is unconscious due to any disease, it may be irregular, exceed the norm in frequency, or be significantly less frequent. This condition is regarded as a breathing disorder, but is not called shortness of breath.
• Shortness of breath is also considered a condition (which cannot be measured by any methods) - the presence of patient complaints of a feeling of lack of air with normal indicators of respiratory rate and rhythm, and shortness of breath occurs only with an increase in the depth of inhalation acts.

Thus, the accepted definition, as well as the definition of Academician B.E. Votchal, considers this symptom as a psychological subjective perception, awareness of physiological or pathological stimuli and changes in the body.

A person describes shortness of breath, like pain, with a variety of colorful emotional expressions:

• feeling of suffocation
• lack of air
• feeling of chest fullness
• feeling of lack of air in the lungs
• "chest fatigue"

Shortness of breath can be both physiological, “safe” - a normal reaction of the body, and pathological, since it is one of the symptoms of a number of diseases:

Physiological changes in breathing that quickly return to normal

• during running, sports exercises in the gym, swimming in the pool
• quickly climbing stairs
• when performing heavy physical activity
• with a pronounced emotional reaction in a healthy body (anxiety, stress, fear)

Pathological reactions that occur in diseases

Shortness of breath during exertion occurs even with low intensity and slight exertion. The cause of shortness of breath when walking is diseases of the lungs, heart, anemia, diseases of the endocrine system, nervous system, etc.

Mechanisms of symptom formation

Unfortunately, very often many doctors associate the mechanism of occurrence and development of shortness of breath only with:

• obstruction (obstruction) of the airways at a distance from the vocal cords in the larynx to the alveoli
• with heart failure leading to congestion in the lungs.

Based on these (often erroneous) conclusions, a plan for further instrumental and laboratory diagnostic examinations and treatment is drawn up.

However, the pathogenesis of shortness of breath is much more complex, and there are many more reasons for it. There are many assumptions about the development of shortness of breath. The most convincing theory is based on the idea that the brain perceives and analyzes impulses that enter it as a result of a discrepancy between the stretch and tension of the respiratory muscles.

The degree of irritation of the nerve endings that control muscle tension and transmit signals to the brain does not correspond to the length of these muscles. It is assumed that it is precisely this discrepancy that causes a person to feel that the inhalation being taken is too small in comparison with the tension of the respiratory muscle group. Impulses from the nerve endings of the respiratory tract or lung tissue enter the central nervous system via the vagus nerve and form a conscious or subconscious feeling of breathing discomfort, that is, a feeling of shortness of breath.

The described scheme gives a general idea of ​​the formation of dyspnea. It is suitable only for partial justification, for example, of the cause of shortness of breath when walking or other physical activity, since in this case the irritation of chemoreceptors by the increased concentration of carbon dioxide in the blood is also important.

A large number of causes and variants of pathogenesis are due to the variety of physiological processes and anatomical structural units that ensure normal breathing. One or another mechanism always prevails, depending on the situation that provoked it. For example, it can occur due to irritation of the receptors of the larynx or trachea, medium and small bronchi, respiratory muscles, all at the same time, etc. However, the principles of implementation and mechanisms for the occurrence of shortness of breath under different circumstances are the same.

So, shortness of breath is characterized by awareness of excessive activation of the brain by impulses from the respiratory center in the medulla oblongata. It, in turn, is brought into an active state by ascending signals arising as a result of irritation of peripheral receptors in various structures of the body and transmitted through nerve pathways. The stronger the irritants and respiratory dysfunction, the more severe the shortness of breath.

Pathological impulses can come from:

• The centers themselves are in the cerebral cortex.
• Baroreceptors and mechanoreceptors of the respiratory muscles and other muscles or joints.
• Chemoreceptors that respond to changes in the concentration of carbon dioxide and are located in the carotid bodies of the carotid arteries, aorta, brain and other parts of the circulatory system.
• Receptors that respond to changes in the acid-base state of the blood.
• Intrathoracic endings of the vagus and phrenic nerves.

Examination methods

To prove the presence of shortness of breath and establish its causes, additional methods of instrumental and laboratory research help, to some extent. These are:

• special questionnaires with a multi-point system of answering questions;
• spirometry, which measures the volume and speed of inhalation and exhalation of air;
• pneumotachography, which allows you to record the volumetric velocity of air flow during quiet and forced breathing;
• testing using dosed physical activity on a bicycle ergometer or treadmill;
• carrying out tests with drugs that cause narrowing of the bronchi;
• determination of blood oxygen saturation using a simple pulse oximeter device;
• laboratory study of the gas composition and acid-base state of the blood, etc.

Clinical classification of types of shortness of breath

In practical medicine, despite the nonspecificity of shortness of breath, it is still considered in combination with other symptoms as a diagnostic and prognostic sign for various pathological conditions and processes. There are many classifications of variants of this symptom, indicating a connection with a specific group of diseases. In many pathological conditions, according to the main indicators, it has a mixed development mechanism. For practical purposes, shortness of breath is divided into four main types:

• Central
• Pulmonary
• Heartfelt
• Hematogenous

Dyspnea of ​​central origin - with neurology or brain tumors

It differs from all others in that it itself is the cause of disturbances in gas exchange processes, while other types of shortness of breath arise as a result of already impaired gas exchange and are compensatory in nature. Gas exchange during central dyspnea is disrupted due to pathological depth of breathing, frequency or rhythm that is not adequate to metabolic needs. Such central disturbances may occur:

• as a result of overdose of narcotic or sleeping pills
• for tumors of the spinal cord or brain
• neuroses
• pronounced psycho-emotional and depressive states

In psychoneurotic disorders, complaints of shortness of breath are usually made by 75% of patients being treated in the clinic for neurotic conditions and pseudoneuroses; these are people who react acutely to stress, are very easily excitable, and hypochondriacs. A feature of psychogenic breathing disorders is considered to be noise accompaniment - frequent groaning, heavy sighs, groans.

• such people experience a constant or periodic feeling of lack of air, the presence of an obstruction in the larynx or in the upper parts of the chest
• the need for additional inspiration and the impossibility of its implementation “breathing corset”
• they try to open all the doors and windows or run out into the street “for air”
• Such patients feel in the absence of pathology, are confident in the presence of heart failure and experience the fear of death from suffocation with indifference to the presence of other diseases.

These disorders are accompanied by an unreasonable increase in the frequency or depth of breathing, which does not provide relief, and the inability to hold the breath. Sometimes false attacks of bronchial asthma or laryngeal stenosis occur after any experiences or conflicts, causing confusion even for experienced doctors.

Central shortness of breath can manifest itself in various ways:

Tachypnea

Tachyponoe is a sharp increase in respiratory rate to 40 - 80 or more per minute, which leads to a decrease in carbon dioxide in the blood and, as a result:

• to weakness
• dizziness
• decrease)
• loss of consciousness

Tachypnea can occur with pulmonary embolism, pneumonia, peritonitis, acute cholecystitis, neuroses, especially with hysteria, muscle disorders, high temperature, flatulence and other conditions.

Bradypnea

Deep, but rare, less than 12 breaths per minute, which occurs when air transport through the upper respiratory tract is difficult. This type of shortness of breath occurs:

• when using drugs
• brain tumors
• Pickwick's syndrome

when breathing during sleep is accompanied by a stop for up to 10 seconds or more, after which tachypnea occurs upon full awakening.

Dysrhythmia

Violation of the breathing rhythm in amplitude and frequency.

• It occurs, for example, with aortic valve insufficiency, when when the left ventricle of the heart contracts, an increased volume of blood enters the aortic arch, and therefore the brain, and when the ventricle relaxes, a sharp reverse outflow of blood occurs due to the absence of an obstacle, that is, the presence of a deformed valve aorta.
• This is especially pronounced during psycho-emotional stress, which causes “respiratory panic” and fear of death.

Shortness of breath due to heart failure

One of the main symptoms of heart disease is shortness of breath. The most common cause is high pressure in the blood vessels of the heart. At first (in the early stages), patients with heart failure experience a kind of “lack of air” only during physical exertion; as the disease progresses, shortness of breath begins to bother them even with slight exertion, and then at rest.

Dyspnea in heart failure has a mixed mechanism, in which the predominant role belongs to the stimulation of the respiratory center in the medulla oblongata by impulses from the volume and baroreceptors of the vascular bed. They, in turn, are caused mainly by circulatory failure and stagnation of blood in the pulmonary veins, increased blood pressure in the pulmonary circulation. Also important is the violation of the diffusion of gases in the lungs, the violation of elasticity and compliance to stretching of the lung tissue, and a decrease in the excitability of the respiratory center.

Shortness of breath in heart failure is characterized by:

Polypnea

when an increase in gas exchange is achieved through deeper and more frequent breathing at the same time. These parameters depend on the increasing load on the left side of the heart and the pulmonary circulation (in the lungs). Polypnea in heart disease is mainly provoked by even minor physical activity (climbing stairs); it can occur at high temperatures, pregnancy, when changing the vertical position of the body to horizontal, when bending the body, and heart rhythm disturbances.

Orthopnea

This is a condition in which the patient is forced to be (even sleep) in an upright position. This leads to the outflow of blood to the legs and lower half of the body, unloading the pulmonary circulation and leading to easier breathing.

Cardiac asthma

Nocturnal paroxysm of shortness of breath, or cardiac asthma, which is the development of pulmonary edema. Shortness of breath is accompanied by a feeling of suffocation, dry or wet (with foamy sputum) cough, weakness, sweating, and fear of death.

Pulmonary dyspnea

It is provoked by a violation of respiratory mechanics due to bronchitis, pneumonia, bronchial asthma, dysfunction of the diaphragm, and significant curvature of the spine (kyphoscoliosis). The pulmonary variant of shortness of breath is divided into:

Inspiratory dyspnea - difficulty breathing

With this type of shortness of breath, all auxiliary muscles take part in the act of inhalation. It occurs:

• with difficulty breathing in case of loss of elasticity of the lung tissue due to pneumosclerosis, fibrosis, pleurisy, widespread pulmonary tuberculosis, lung cancer
• coarse pleural deposits and carcinomatosis
• high position of the diaphragm due to pregnancy
• phrenic nerve palsy due to ankylosing spondylitis
• in patients with bronchial asthma with narrowing of the bronchi as a result of pneumothorax or pleurisy
• inspiratory dyspnea may be caused by a foreign body in the airway
• laryngeal tumor
• swelling of the vocal cords with laryngeal stenosis (often in children under 1 year of age, see and)

Expiratory dyspnea - difficulty breathing out

It is characterized by difficulty in exhaling due to changes in the walls of the bronchi or their spasm, due to inflammatory or allergic swelling of the mucous membrane of the bronchial tree, and accumulation of sputum. It occurs most often when:

• attacks of bronchial asthma
• chronic obstructive bronchitis
• emphysema

Such shortness of breath also occurs with the participation of not only the respiratory, but also the auxiliary muscles, although less pronounced than in the previous version.

With lung diseases in advanced stages, as well as with heart failure, shortness of breath can be mixed, that is, both expiratory and inspiratory, when it is difficult to both inhale and exhale.

Hematogenous type of shortness of breath

This species is the most rare, compared to previous variants, and is characterized by a high frequency and depth of breathing. It is associated with changes in blood pH and the toxic effects of metabolic products, in particular urea, on the respiratory center. Most often this pathology occurs with:

• endocrine disorders - severe forms of diabetes mellitus, thyrotoxicosis
• liver and kidney failure
• for anemia

In most cases, shortness of breath is mixed. In approximately 20%, its cause, despite detailed examination of patients, remains unknown.

Dyspnea due to endocrine diseases

People with diabetes, obesity, and thyrotoxicosis in most cases also suffer from shortness of breath, the reasons for its appearance in endocrine disorders are as follows:

• For diabetes Over time, changes necessarily occur in the cardiovascular system, when all organs suffer from oxygen starvation. Moreover, sooner or later, with diabetes, kidney function is impaired (diabetic nephropathy), anemia occurs, which further aggravates hypoxia and increases shortness of breath.
• Obesity - it is obvious that with an excess of adipose tissue, organs such as the heart and lungs are subject to increased stress, which also complicates the functions of the respiratory muscles, causing shortness of breath when walking, during exercise.
• For thyrotoxicosis When the production of thyroid hormones is excessive, all metabolic processes increase sharply, which also increases the need for oxygen. Moreover, when hormones are in excess, they increase the number of heart contractions, while the heart cannot fully supply blood (oxygen) to all organs and tissues, hence the body tries to compensate for this hypoxia - as a result, shortness of breath occurs.

Shortness of breath with anemia

Animia is a group of pathological conditions of the body in which the composition of the blood changes, the number of red blood cells and hemoglobin decreases (with frequent bleeding, blood cancer, in vegetarians, after severe infectious diseases, with oncological processes, congenital metabolic disorders). With the help of hemoglobin, the body delivers oxygen from the lungs to the tissues; accordingly, with its deficiency, organs and tissues experience hypoxia. The body tries to compensate for the increased need for oxygen by increasing and deepening breaths - shortness of breath occurs. In addition to shortness of breath with anemia, the patient feels weakness, deterioration of sleep, appetite, headache, etc.

In custody

It is extremely important for a doctor:

• establishing the cause of shortness of breath during physical activity or emotional reaction;
• understanding and correct interpretation of patient complaints;
• clarification of the circumstances under which this symptom occurs;
• the presence of other symptoms that accompany shortness of breath.

No less important is:

• the patient’s general understanding of the shortness of breath itself;
• his understanding of the mechanism of dyspnea;
• timely consultation with a doctor;
• correct description of the patient’s feelings.

Thus, shortness of breath is a symptom complex inherent in physiological and many pathological conditions. The examination of patients must be individual, using all available techniques that allow it to be objectively examined in order to select the most rational method of treatment.