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Emphysema

Breathing difficulty
Definition:

A sensation of difficult or uncomfortable breathing or a feeling of not getting enough air. See also difficulty breathing - first aid.

Difficulty breathing may occur with exercise (dysnpea on exertion) or with certain body positions, especially lying down (positional dyspnea).
Alternative Names:
Shortness of breath; Breathlessness; Difficulty breathing; Winded; Trouble breathing; Dyspnea
Considerations:

No standard definition exists for difficulty breathing. For some, a sense of breathlessness may occur with only mild exercise (for example, climbing stairs) without meaning that there is a specific disease. Others may have advanced lung disease and difficulty exchanging air, but never feel a sensation of shortness of breath.

In some circumstances, a small degree of breathing difficulty may be normal. Severe nasal obstruction is one example. Strenuous exercise, especially when a person does not exercise regularly, is another. In many situations, however, difficulty breathing represents the presence of significant disease, and should be evaluated by a health care provider.

Wheezing is one form of breathing difficulty. See also rapid breathing, apnea, respiratory diseases, lung disease, and other lung disorders.
Common Causes:

Shortness of breath has many different causes. Lung disease, caused by inflammation or irritation of the breathing tubes or air sacs often leads to shortness of breath. Obstruction of the air passages of the nose, mouth, or throat may also lead to difficulty breathing. Heart disease can cause breathlessness if the heart is unable to pump enough blood to supply oxygen to the body. If the brain, muscles, or other body organs do not receive enough oxygen, a sense of breathlessness may occur. Sometimes emotional distress, such as anxiety, can lead to difficulty breathing. Other possible causes include:
Home Care:
Shortness of breath, whether sudden or long term, should always be taken seriously. While many causes are harmless and are easily corrected, shortness of breath requires a thorough medical evaluation.

Follow prescribed therapy to treat the underlying cause.

Rest and relaxation can help a person who has shortness of breath caused by hyperventilation.
Call your health care provider if:
  • there is shortness of breath after only slight exertion or while at rest.
  • you awaken in the night out of breath or have to sleep propped up on several pillows to avoid becoming short of breath.
  • there is any unexplained shortness of breath.
  • wheezing may be an indication of asthma or early emphysema.
  • a young child may have inhaled or choked on an object (foreign object aspiration or ingestion).
  • there is tightness in the throat or a barking, croupy cough.
  • fever or a significant cough occurs.
What to expect at your health care provider's office:
Your health care provider will take a detailed medical history and perform a physical examination performed.

Medical history questions documenting breathing difficulty in detail may include:
  • quality
    • Does the person complain of shortness of breath?
    • Does the person make grunting sounds while breathing?
    • Do they appear to be having to work hard to breathe?
  • time pattern
    • Has it been present for months or years?
    • Did it slowly progress over weeks to months?
    • Did it begin recently?
    • Did it begin suddenly?
    • Did it come on slowly (gradual onset)?
    • Is there a sequence of separate occurrences (episodic)?
      • How long does each last (for how many hours)?
      • Does each repeated episode have a similar pattern (recurrent)?
    • Has the breathing difficulty worsened recently ?
    • Does breathing difficulty cause the individual to awaken at night (paroxysmal nocturnal dyspnea)?
    • Does the amount of breathing difficulty change (variable over hours)?
    • Does breathing difficulty occur at rest?
    • How long does each episode last?
  • aggravating factors
    • Is it worse when lying flat (orthopnea)?
    • Is it worse with a change in body position?
    • Did it develop within 4 to 6 hrs after exposure to something that the person is/may be allergic to (antigen)?
    • Is it worse after exercise?
    • Does shortness of breath occur only when wheezing?
  • other
    • Is the breathing pattern irregular?
    • Does the person draw back the chest muscles with breathing (intercostal retractions)?
    • What other symptoms are also present?
The physical examination will include a thorough examination of the lungs, heart, and upper airway passages.

Diagnostic tests that may be performed include: Intervention:
In severe cases of difficulty breathing, hospitalization may be required. Many different medications, aimed at treating the cause of breathing difficulty, may be used in treatment. In situations where the blood oxygen level is significantly low, supplemental oxygen is helpful, however, it is not necessary in all cases of shortness of breath. High doses of supplemental oxygen may be hazardous for some patients.

After seeing your health care provider:
You may want to add a diagnosis related to breathing difficulty to your personal medical record.
Review Date: 12/6/2001
Reviewed By: David A. Kaufman, M.D., Pulmonary & Critical Care Medicine, University of Pennsylvania Medical Center, Philadelphia, PA. Review provided by VeriMed Healthcare Network.

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