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Breathlessness or dyspnoea is defined and the different kinds of diagnosis, symptoms and causes are discussed. The importance of communication for effective assessment and examination is highlighted.

A hypothesis stating that the respiratory muscle effort and decreased velocity of shortening of respiratory muscles are important determinants of dyspnea intensity in subjects exercising under hyperbaric conditions is tested. It is confirmed that the increased respiratory muscle pressure is necessary to overcome the high respiratory load caused by an increase in dyspnea which is modulated by the lower velocity of shortening of the respiratory muscles.

A case of a 30-year-old man who presented with a 2-month history of progressively worsening dyspnoea, cough, and reduced exercise tolerance is discussed. A chest x-ray and computerized tomography of the chest suggested interstitial lung disease, which was confirmed on histology of an open lung biopsy. Careful questioning revealed that the patient had sustained close exposure to a rosella parrot acquired as a pet 9 months prior to presentation, which led to the diagnosis of bird fancier's lung. The case, investigations, and outcome are presented. This is followed by a discussion on extrinsic allergic alveolitis with particular emphasis on the importance of a complete social and environmental history in patients presenting with similar respiratory symptoms. KEY WORDS: Bird fancier's lung, extrinsic allergic alveolitis, Psittaciformes, Rosella parrot exposure, Bird fancier's lung is a hypersensitivity pneumonitis triggered by inhalation of organic dusts of avian origin. The vast majority of cases is seen in pigeon breeders but numerous other bird [...]

Breathlessness or shortness of breath is most common complaint in conditions like asthma, chest infections, and pulmonary oedema attributable to left ventricular failure. The immediate hospital care and treatment to help the patient recover from the conditions faster are discussed.

The differential diagnosis of dyspnea in patients with prior malignancy and nondiagnostic chest radiographs is broad. We report a case of breast carcinoma diffusely metastatic to the bronchial submucosa presenting [...]

Chronic airflow obstruction (CAO) is a condition that limits the amount of air that can enter the lungs. This makes breathing more difficult and has important consequences on the ability to breath while performing normal daily activities, especially during exercise. Patients with CAO have difficulty performing daily activities that require prolonged use of the arms. Just raising the arms can cause severe and disabling dyspnea (shortness of breath). To determine how raising the arms affects the ability to breath, 20 patients with CAO were studied. The patients performed an arm exercise (AE) that required the arms to be held out straight at shoulder level for two minutes. Before and after the exercise, lung function was determined by measuring the amount of oxygen taken in (VO2), the amount of carbon dioxide formed (VCO2), and the volume of gas exhaled from the lungs during a one minute period (VE). Within 30 seconds of beginning the AE, VO2, VCO2, and VE increased. AE caused the patients to breathe faster, but the amount of air inhaled and exhaled during a single breath did not change. Further studies showed that raising the arms to shoulder level not only requires the use of arm muscles, but also requires the use of diaphragm and rib cage muscles that are used during breathing. This means that these muscles have to work harder to maintain normal breathing while the arms are lifted. These findings help to explain why patients with CAO have difficulty breathing while performing daily activities that require arm movement. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dyspnea is characterized by difficult or labored breathing. It has also been described as a shortness of breath, distress in breathing, or a feeling of breathlessness. Dyspnea refers to the uncomfortable sensation of the need to breath when breathing has stopped for some reason. The sensation of dyspnea can occur during intense exercise or at high altitudes, but usually does not occur in healthy, athletic individuals. Dyspnea is a common symptom in individuals with heart or lung disease. In order to determine if different types of dyspnea exist, 53 patients with shortness of breath answered a questionnaire about the sensation that dyspnea produces. The patients were divided into seven groups based on their medical conditions. The groups were: pulmonary vascular disease (6 patients); lung disease (9); congestive heart failure (CHF, 5); neuromuscular and chest wall disease (5); chronic obstructive pulmonary disease (COPD, 16); asthma (7); and pregnancy, first and second trimesters, (5). Different feelings or sensations of dyspnea were reported by the different groups. The patients with neuromuscular/chest wall disease, asthma, and CHF were most likely to experience feelings that their breathing requires more work or is shallow, the feeling of a tight chest and inability to exhale all the way, or a feeling of suffocating, respectively. The patients with pulmonary vascular disease, pregnancy, lung disease and COPD had feelings of rapid breathing, can't get enough air, more work required for breathing, and a combination of not enough air and more work required, respectively. These results indicate that different diseases may produce different sensations of dyspnea. Further classification of the different types of sensations may be a useful tool in the diagnosis of underlying conditions of heart or lung disease. The mechanisms responsible for producing the different sensations of dyspnea are not known. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dyspnea is defined as difficult, labored, and uncomfortable breathing. It is a subjective condition and may be interpreted differently in various clinical studies. There are several possible mechanisms for the development of dyspnea, which can be put into four categories: disturbance of chemosensitivity, pulmonary receptors, respiratory muscle receptors, and outgoing respiratory motor command. Dyspnea is a frequently a chief manifestation of respiratory and cardiac disease. Some patients may be more aware of the presence of dyspnea than others and this is a perplexing problem for clinicians. Since dyspnea is a subjective sensation, there may be variations in the level of dyspnea necessary for a specific degree of functional impairment to occur. Treatment of dyspnea rests on treatment of the underlying condition. Although bronchodilators are useful in relieving dyspnea in patients with asthma, they are not completely effective for patients with chronic obstructive pulmonary disease (COPD). Supplemental oxygen has resulted in a decrease in dyspnea and improved exercise tolerance in patients with COPD. Some patients have also had a decrease in dyspnea when seated near an open window or a fan. There is still a lot to learn about the causes of dyspnea in patients with cardiopulmonary diseases. Researchers still need to determine why some patients display more distress than others. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chronic obstructive pulmonary disease (COPD), which is related to diseases such as emphysema, causes long-term changes in lung and heart function. Dyspnea, or labored breathing, frequently accompanies COPD, and stabilization of dyspnea is a frequent goal of COPD treatment. Dyspnea is similar to pain, in that it results from mind-body interactions, and subjective assessment of its severity may be altered by patient anxiety, depression, and somatization (expression of mental state as disturbed body functioning). Changes in blood levels of hormones such as cortisol, which are linked to anxiety, are thought to be related to dyspnea; but this has not been previously studied. Six male patients with COPD were assessed to determine the differences in anxiety, depression, and somatization during times of mild and severe dyspnea. The study found that during times of severe dyspnea, accessory respiratory muscles were more active and the levels of carbon dioxide in the blood increased; both of these symptoms are associated with labored breathing. Patients had higher anxiety levels and higher levels of cortisol. In addition, patients who received the steroid drug prednisone were more depressed during severe dyspnea, and also had higher levels of somatization throughout the study. This study indicates that the treatment of COPD patients should include consideration of the patient's emotional state. (Consumer Summary produced by Reliance Medical Information, Inc.)

Practice recommendations * Don't pour psyllium powder into medicine cups: spoon it or combine it with a liquid (C). * Use respiratory protection, such as a chemical hood or HEPA [...]

Methods of diagnosis and treatment of diffuse parenchymal lung diseases are described. The different conditions within the group of diseases, the main causes of the disease, and treatment or surgery options are explained.

An 80-year-old woman presented with progressive shortness of breath. There was no history of pulmonary or cardiac disease. Results of a physical examination were normal. She had significant oxygen desaturation [...]

This issue of CHEST (see pages 1681 and 1682) contains two separate case reports, each describing a patient with a patent foramen ovale, and each patient manifesting platypnea (increased dyspnea [...]

High resolution computed tomography (HRCT) can prove useful in diagnosing the cause of shortness of breath in patients with rheumatoid arthritis (RA). Two case histories are presented, one a 61-year-old man and the other a 56-year-old woman. Both had RA and both presented with breathing difficulty and decreased lung function. Neither could be diagnosed from clinical examination, chest X ray, or lung function tests. A conventional CT scan does better at displaying the lung but does not supply sufficient image resolution. The HRCT enabled doctors to diagnose fibrosing alveolitis (thickening connective tissue) in the man and obstructive bronchiolitis (inflammation of the smaller branches of the breathing passages) in the woman. These complications were due to RA in both cases.

A Recent Experience and Diagnostic Value of Dynamic Magnetic Resonance Imaging Shortness of breath after pneumonectomy is a common finding that has multiple causes. We report the cases of two [...]