Shortness Of Breath (Dyspnea) : Causes, Symptoms, Diagnosis & Treatment

Shortness of breath, medically known as dyspnea, is the uncomfortable sensation of having difficulty breathing or feeling unable to get enough air. It can be a symptom of a wide range of medical conditions, from mild to life-threatening.

Definitions

Dyspnoea is a subjective feeling of difficulty in breathing.
Hyperventilation is a sensation of dyspnoea associated with excessive breathing.

CAVEATS

• Not all cases of dyspnoea are caused by cardiorespiratory pathology. Always exclude metabolic causes, especially in patients without lung findings.
• It may be the only presenting symptom of acute coronary syndrome, especially in the elderly, hence ECG should be performed early.
• The common causes of acute breathlessness are shown in Table 1.

TABLE 1 Common causes of acute breathlessness

Clinical Assessment

History

• Associated symptoms, e.g., cough, chest pain, fever, lower limb swelling.
• Exacerbating and relieving factors.
• Exposure to allergens or poisons, e.g. poisoning or anaphylaxis.
• Past medical history, e.g. asthma, congestive cardiac failure (CCF).
• Medication history.
• Recent trauma.

Physical examination

• General appearance: cyanosis, confusion, drowsiness, tachypnoea, pallor.
• Cardiovascular: evidence of heart failure (raised jugular venous pressure [JVP]), pedal oedema, lung crepitations), equality of pulses (in aortic dissection).
• Respiratory: lung crepitations, air entry good and equal.
• Others, e.g. skin: urticaria, severe dehydration in patients with diabetic ketoacidosis, evidence of trauma.

Investigations

• Arterial blood gas: to determine metabolic and/or respiratory cause of dyspnoea.
• ECG: especially in elderly patients who usually present atypically with dyspnoea in acute coronary syndrome.
• DXT: should be obtained in cases of metabolic acidosis.
• Chest X-ray: generally indicated to detect for cardiorespiratory pathology.
• Others: FBC, RP, Drug test.

Management

The principles of management of patients presenting with dyspnoea include the following:

1. Resuscitation and stabilization of the following life-threatening conditions that must be treated within seconds or minutes:
   • Acute upper airway obstruction.
   • Tension pneumothorax.
   • Acute respiratory failure
2. Supportive treatment.
3. Treat the underlying cause of the dyspnoea.

Treatment

Supportive measures:

1. The patient should be placed in a monitored area.
2. Monitoring: ECG, pulse oximetry, and vital signs.
3. Secure airway if needed.
4. Supplemental oxygen.
5. Obtain IV access and administer fluids depending on the diagnosis and patient’s haemodynamics.

Treatment of the identified cause of acute breathlessness.

Disposition of the patient would depend upon the diagnosis and the clinical state of the
patient.

When to Seek Emergency Help!

Call emergency services if shortness of breath is sudden or accompanied by:

• Chest pain or pressure
• Fainting or confusion
• Severe dizziness
• Blue lips or face