Shortness of Breath

Abdulrahman Al FrayhProfessor of Pediatrics

Consultant Pediatric PulmonologistKing Saud University

Definition

Shortness 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 SOB

PULMONARY 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.

Trauma

Chest injuries, both closed

injuries and penetrating wounds,

can cause pneumothorax, bruises, or

fractured ribs. Pain from these injuries

results in SOB.

Other Causes

Anxiety 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, causing

chest pain.

Chronic SOB

PULMONARY 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 include

muscular dystrophy, myasthenia gravis, and Werding Hoffman Disease.

Other Causes

Patients 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 Tests

BASIC 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.

Thank You…