Overview of pulmonary dyspnea
Pulmonary dyspnea (dyspnea of pulmonary origin) refers to a respiratory disease that causes the patient to feel that there is not enough air, and that breathing is laborious, accompanied by abnormal respiratory rate, depth, and rhythm. In severe cases, nasal flaring, open-mouth or sitting breathing may occur. When the respiratory organs themselves are diseased, the inhalation and excretion of gases are impaired, the respiratory area of the lungs is reduced, the elasticity of the lung tissues is reduced, there is a lack of oxygen and an increase in carbon dioxide in the blood, which leads to the excitation of the respiratory center, such as diseases of the narrowing of the upper respiratory tract, chronic alveolar emphysema, various kinds of pneumonitis, pulmonary edema, pleuropneumonia, pleurisy, etc. It may be accompanied by abnormal or pathologic breath sounds.
Etiology
The common causes are:
1. Airway obstruction
Such as inflammation of the larynx, trachea, bronchus, edema, stenosis or obstruction caused by tumor or foreign body and bronchial asthma, chronic obstructive pulmonary disease.
2. Lung diseases
Such as pneumonia, lung abscess, tuberculosis, pulmonary atelectasis, pulmonary stasis, pulmonary edema, diffuse interstitial lung disease, fine bronchioloalveolar carcinoma, etc.
3. Diseases of chest wall, thorax and pleural cavity
Such as chest wall inflammation, severe thoracic deformity, pleural effusion, spontaneous pneumothorax, extensive pleural adhesion, tuberculosis, trauma, etc.
4. Neuromuscular diseases
Such as poliomyelitis involving the cervical cord, acute polyradiculoneuritis and myasthenia gravis involving the respiratory muscles, drug-induced respiratory muscle paralysis.
5. Diaphragmatic movement disorder
Such as diaphragmatic paralysis, large amount of abdominal fluid, huge tumors in the abdominal cavity, gastric dilatation and the end of pregnancy.
Symptoms
According to the relationship between dyspnea and activity, it is divided into three degrees: mild, moderate and severe.
1. Mild: Dyspnea occurs only during heavy physical activity.
2. Moderate: Dyspnea occurs with light physical activity.
3. Severe: Dyspnea occurs even in a quiet resting state. Severe dyspnea may be characterized by sit-up breathing, i.e., the dyspnea worsens when the patient lies down and decreases when the patient sits up, forcing the patient to take a sitting position.
Examination
Laboratory tests need to analyze, summarize, and select based on the objective materials learned from the history and physical examination, from which several diagnostic possibilities are proposed, and further consider which laboratory tests are helpful for diagnosis. For example, pulmonary function tests, cardiac function tests, lung X-rays, arterial oxygen partial pressure, carbon dioxide partial pressure and other tests.
Diagnosis
Based on the patient’s history, clinical manifestations, and laboratory and imaging tests, the site and cause of the disease can be basically clarified.
Differential diagnosis
1. Dyspnea with increased abdominal pressure
In the case of acute gastric dilatation, abdominal effusion, etc., the abdomen exerts great pressure on the chest, which obstructs the respiratory movement and leads to dyspnea.
2. Cardiac dyspnea
Due to the abnormal function of the heart, resulting in circulatory dysfunction, especially in the case of pulmonary circulation disorders, gas exchange is affected, and the inhalation and excretion of oxygen and carbon dioxide are disorganized, resulting in mixed dyspnea, which can be seen in heart failure, myocarditis, pericarditis and endocarditis, etc. The patients are usually hypertensive, coronary artery disease and hypertension, which can lead to dyspnea. Most patients have hypertension, coronary arteriosclerotic heart disease, rheumatic heart disease or mitral stenosis and other underlying diseases.
3. Hematogenous dyspnea
Due to the decrease in the number of red blood cells or the degeneration of hemoglobin, the oxygen-carrying capacity decreases and the blood oxygen is insufficient, resulting in dyspnea, which can be seen in various types of anemia.
4. Toxic dyspnea
Toxic substances produced by metabolism in the body directly act on the respiratory center; or toxic substances entering from outside the body act on hemoglobin to reduce the oxygen-carrying capacity, lack of oxygen, carbon dioxide accumulation, resulting in respiratory distress. It can be seen in metabolic acidosis, uremia, ketonemia, nitrite poisoning, hydrocyanic acid poisoning.
5. Central dyspnea
It is mainly due to severe brain diseases, so that the intracranial pressure rises and inflammatory products stimulate the respiratory center, causing dyspnea. It is seen in cerebral hemorrhage, cerebral edema, brain tumor, meningitis and so on.
Treatment
1. Treatment for the cause of the disease.
2. Symptomatic treatment
If there is hypoxic dyspnea, continuous low-flow suction 02. Secondary infection should be treated with anti-infection therapy as appropriate. Prevent complications caused by long-term use of GCS or (and) immunosuppressants.
Prevention
1. Actively treat the primary disease, must be under the guidance of the doctor to use drugs, if the use of drugs is not appropriate, it may aggravate the condition.
2. Exercise to enhance physical fitness, ensure adequate sleep, eat more vitamin-rich foods, learn to regulate their emotions, and when in a happy mood, the immune system will be strengthened.
3. Keep the air in the hospital room fresh, with appropriate temperature and humidity, avoid irritating gases, and ensure that patients have a good rest. For those with severe respiratory distress, minimize unnecessary conversations to reduce oxygen consumption.
4. Ensure adequate daily intake of calories, avoid irritating and gas-producing foods, and prevent constipation and bloating from affecting breathing.